A Fallen Hero - Video Inside

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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

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In April, using survey data from the registry, the city published a study of 8,418 survivors of the Twin Towers. That study found that half of those people reported one or more new respiratory symptoms after 9/11.

The authors of the study went on to list all of the problems with their conclusions. For one thing, they say, the total number of building survivors is unknown. For another, the data are based on the memories of people taking a survey two or three years after the fact. And the survey never established the boundaries of the dust cloud.

Finally, the people in the study were those who signed up for the registry—possibly biasing the sample. "This effect has been observed in other environmental studies in which persons who believed they were exposed tend to over-report health problems," the authors write.

In the spectrum of scientific knowledge, the strongest evidence of a link between the dust and respiratory illness is provided by the city's firefighters.

The FDNY had been collecting respiratory data on its members years before 9/11. As a result, doctors were able to compare the lung conditions of their patients before and after the attacks.

More than 3,000 firefighters have sought respiratory treatment since 9/11. Retirements based on lung problems have risen by four times the previous average. The observed drop in lung function after 9/11 was 12 times greater than the average annual decline in the five years before 9/11. More than 25 percent of firefighters showed symptoms of asthma or reactive airway dysfunction.

The most recent study of firefighters, published in March, concluded that 26 firefighters contracted a respiratory disease, sarcoidosis, in the five years after 9/11—a rate higher than in the 15 years prior to 9/11. Half of those firefighters got the disease in the first year after the attack, and the remainder over the next four years.

"It's striking data—way above the norm even for their population," Carpenter says. For most of the other affected groups, however, data for the period prior to 9/11 generally do not exist, which makes it much more difficult to make judgments with the same kind of precision.

The New York Police Department, for example, is only now seeking funding to do a wide-ranging study of the thousands of police officers who worked at the site. That effort has been criticized by police unions for coming too late—and at a time when the NYPD is fighting disability claims.

In a study released last week, the city reported that 3.6 percent of 25,000 Ground Zero workers said that they had developed asthma after working at the site—a rate 12 times higher than that of the general population.

The survey also found that workers who were caught in the cloud or worked on the debris pile reported higher rates of asthma, and that those who wore dust masks reported asthma at a lower rate than those who did not. In other words, the higher your exposure, the greater your likelihood of reporting asthma.

The research evidence on severe respiratory disease, however, is limited. Other than the study of sarcoidosis in firefighters, there are just three other studies on severe respiratory disease, with each one examining a single specific case of three separate illnesses.

"It's hard to document and identify small elevations in rare events, so it takes a lot of work," says Lorna Thorpe, deputy commissioner of the city's health department. "Of the broader, more common ailments—cough, asthma, wheezing—they are very common in the general population, so it's not as easy to verify. The question of persistence of symptoms is of paramount importance."

The most persuasive study to date was released in September 2006 by the Mount Sinai WTC Medical Monitoring Program.

The study concluded that Ground Zero responders suffered exposure-related increases in respiratory- and pulmonary-test abnormalities that lingered up to 2.5 years after the attacks, with those who reached the site within the first two days of the attacks experiencing the worst symptoms.

Of the 9,442 responders tested between July 2002 and April 2004, 69 percent reported new or worsened respiratory symptoms after being involved in WTC work, the study found. The symptoms persisted in 59 percent of those workers. And 61 percent of the workers without prior symptoms developed breathing troubles after 9/11.

One in four had abnormal breathing-test results. Among nonsmokers, 27 percent had abnormal results, compared with 13 percent in the general population. The prevalence of low lung capacity among nonsmokers was five times greater than in the general U.S. population.

"There should no longer be any doubt about the health effects of the World Trade Center. Our patients are sick," says Dr. Robin Herbert, co-director of the Mount Sinai program.

Phillip Landrigan, one of the study's authors, says that the caustic dust caused burning and scarring in the lungs, leading to the shrinking of tissues and "functional abnormalities."

"There is a high likelihood that a lot of this impairment is going to be permanent," says Landrigan.

The authors of the study proposed that WTC workers should be tracked for "at least 20 to 30 years." About 6,500 people are being treated in Mount Sinai and other hospitals by a federally funded consortium.

The authors acknowledge limitations in the study, the chief one being that they did not have pre–September 11 clinical data. And they note that the sicker responders were more likely to sign up for the clinic, which could skew the percentages.

Officials with the city's health department have also attempted to describe the array of illnesses cropping up in the WTC population.

In March, city health commissioner Thomas Frieden wrote an article in which he listed persistent mental-health ailments and mild to severe respiratory problems. Some people found that pre-existing conditions like asthma got worse, he wrote; others developed new symptoms or illnesses. People who were caught in the dust cloud had the highest risk of exposure.

But Frieden said the exact number of people who developed severe respiratory illness is still unknown. Also unknown is how many people have respiratory symptoms today, which illnesses are most common, and what factors other than dust-cloud exposure contributed to those illnesses.

The Frieden article came six months after the health department finally issued guidelines for doctors that listed 12 "potentially WTC associated conditions," including asthma, heartburn, throat irritation, acid reflux, and shortness of breath. More serious illnesses, such as interstitial lung disease, chronic bronchitis, and pneumonia, were listed as "currently under evaluation"—in other words, not necessarily related to the dust. The document also includes a giant disclaimer: "The physical health problems discussed in this publication are common and may not be WTC-related even among persons exposed to the disaster."

Kathy Burns, a Massachusetts-based toxicologist, says the guidelines should have been released much sooner.

"An awful lot of the patients were repeatedly misdiagnosed, partly because there wasn't an awful lot of information being put out by the state or the city," Burns says. The DOH guidelines, she adds, came "way too late. . . . And it covered only a small subset of what in the long run will be a problem."

End Part II

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Other advocates say that the reason more isn't known about these WTC-related ailments today is that the Bush administration acted too slowly, or even resisted funding research and monitoring programs.

"The main reason we don't have more information is that the federal government hasn't done the research," Maloney says. "The answer is not unknowable."

When it comes to cancer, obtaining the data that will either establish or disprove a link with toxic WTC dust is still years away, researchers say. But that hasn't stopped advocates from pressing the point that the dust has already caused the disease to show up in responders.

David Worby, the lead attorney in the class-action lawsuit, has said in the Voice that among his 10,000 clients are at least 400 cancer cases—a fact, he asserts, that demonstrates a clear link between the dust cloud and cancer. A series of other media reports have also made that connection.

The theory goes that the unprecedented toxic mixture of chemicals in the dust weakened the immune systems of Ground Zero workers to the point that they have become far more susceptible to serious illness—especially if they'd been exposed to toxins earlier in their lives.

In particular, dozens of cases of blood-cell cancers—like lymphoma and multiple myeloma—among relatively young Ground Zero workers have raised these concerns. Herbert, the Mount Sinai researcher, was quoted as suggesting that such cancers could become a "third wave" of ailments.

"Doctors have told me that this cocktail of poison could very well cause cancer," says Representative Carolyn Maloney, who has become a leading advocate on the issue.

For the families of Ground Zero responders, the link with cancer is very real and deeply troubling. Just ask Michelle Shore, whose husband Robert, a city correction officer who worked at Ground Zero, died of pancreatic cancer in August 2005.

Shore did have heart problems, but otherwise he was fine, his wife says. "He was a healthy man, but he was misdiagnosed and forced into retirement. Now I've lost my house—everything—and I'm living with my parents. We're all struggling."

Nearly two years after Shore died, the city agreed to pay workers' compensation to his family. Michelle will get $400 a week, but the payments stop if and when she remarries.

But despite the certainty of Michelle Shore and others, tying cancer to the 9/11 cloud is a tricky thing. People in this city routinely succumb to the disease as a matter of course; among New Yorkers, cancer is the second leading cause of death. According to local mortality rates, in a random population of 70,000—about the number of people enrolled in the WTC registry—you would expect roughly 90 cancer deaths per year, primarily from lung, colon, breast, and prostate cancers.

And in a population of 400,000—the estimated number of people exposed at Ground Zero—you could expect as many as 3,000 people to die of cancer over a six-year period.

No one has yet done a study that attempts to compare cancer rates or cancer fatalities in that Ground Zero population to other groups.

Thorpe says that no data currently exist to show that people exposed to the 9/11 dust cloud are dying of cancer at a higher rate than any random sample of New Yorkers.

"Irrespective of their exposure, some of these people would have developed cancer," Thorpe says. "One or two years later, there's some cause to be cautious in making that leap. That said, this was an intense exposure, it has health ramifications, and we need to stay focused on it."

Similarly, the same FDNY doctors who detailed the increase in respiratory ailments among firefighters say that a preliminary analysis shows "no clear increase" in cancers since 9/11.

Johns Hopkins researchers Samet and Geyh write in their paper that asbestos exposure is "unlikely to have been sufficient to cause asbestosis or a measurable increase in the risk of lung cancer." An increased risk for mesothelioma—the disease commonly tied to asbestos exposure—"would not become evident for decades." And the long-term risk of cancer, the authors say, "will be difficult to measure with any precision."

A May 31 study in The New England Journal of Medicine concluded that Ground Zero dust samples did contain fire-related carcinogens, but that "any associated increased risk for respiratory tract and most other cancers will not become apparent for decades." And city health commissioner Frieden likewise has said that it is unknown whether cancers will develop as a result of exposure.

The irony is that even in the best of circumstances, it is extraordinarily difficult to prove that a specific source has caused cancer. In fact, studies of cancer clusters are often inconclusive simply because the mechanism that causes such ailments is still unknown.

In order to verify the relationship, researchers say, one would have to compare the Ground Zero population to a similar but unexposed group and see whether the cancer rates are higher. But there are so many unknowns and variables at play that it would be a very difficult study to do with precision. Even identifying a group of people that could be compared to the Ground Zero population would be difficult.

"In the ideal world, you might try to gather up people exposed and try to understand what they were exposed to," Samet says. "The question is: How well can we reconstruct what people were exposed to, and could enough people be assembled to do that? The hard part would be finding these people. We'll have to see."

In many ways, the very scale of the issue—to say nothing of the uncertainty and cost—has created something of a muddle and left government officials pursuing a schizophrenic course.

The city is a great example of that. Even as it funds the Bellevue clinic, backs the WTC registry, and pursues further research, it is also fighting a rear-guard action against disability and workers' comp claims—arguing, according to a lawyer involved in those cases, that there is no concrete proof that individual workers have gotten sick from a specific illness related to the dust.

And in papers filed opposing the class- action lawsuit brought by 10,000 ailing people, the city has argued that it is immune from lawsuits because it was acting in an emergency. In legal papers, lawyers for the city slam the plaintiffs for "second-guessing decisions made during a time of crisis."

Joel Shufro, of the Committee for Occupational Safety and Health, acknowledges that all of the outstanding health questions may never be answered. "But it does seem to me that at some point, if you have significant numbers of people developing illness, you have a problem," he says. "To take the other side of it—to say, because there is no scientific certainty, that people aren't entitled to treatment—is equally presumptive."

For Shufro, the research is almost a secondary question: "Talk to people who lost their homes, who had to take kids out of college, and ask them whether this is a result of their exposure," he says. "Their lives changed overnight. In the final analysis, what we're talking about here is how does this society respond to people—and where do you draw the line in terms of care for people who are ill?"

Many have looked to the federal government to fund a long-term health-care program for the workers. Nadler, Maloney, and Senator Hillary Clinton have all submitted bills that would make 9/11 health expenditures part of the annual federal budget—but estimates of the cost of that program vary widely.

A city report estimated that the cost of medical care for Ground Zero workers could be as high as $392 million a year. A federal estimate placed the total at $230 million to $283 million a year, but also said the total could be much higher—$400 million, or even as much as $700 million—if a lot more workers sign up. Even at $283 million a year, the costs, over 20 years, total $5.7 billion.

The September 11th Victim Compensation Fund has already paid out $573.2 million for 1,377 asthma and other respiratory claims. Some are seeking to reopen that fund.

There is also a $1 billion federal insurance fund set aside to pay out judgments in the event the city loses in court to the thousands of people suing. In July, a group of responders sued the fund (known as the WTC Captive Insurance Co.), demanding that the money be released.

The feds have contributed $125 million for study and treatment, and they've allocated another $50 million earlier this year. A bill that would provide for another $55 million has passed the House and is now in the hands of the Senate.

The estimate to continue the current programs just for first responders and New York City residents is $178 million a year. That money wouldn't include people outside New York City or federal workers.

But Carpenter, the SUNY Albany epidemiologist, and others say that the government has little choice but to fund care and treatment—in other words, to give everyone the benefit of the doubt. Waiting for conclusive proof would come far too late for people who need help now.

"I think we are going to see people develop illnesses 20 to 30 years down the road," Carpenter says. "I think we need to follow everyone exposed."

"The commitment to all of the workers has to remain a sustained commitment over time," adds Thorpe, the city deputy health commissioner.

Samet, the Johns Hopkins researcher, argues that the government must take a long-term view: "What government should be doing here is the best possible surveillance and tracking, so they can say whether this is different from any other population. That's not going to be easy."

End

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TWO 9/11-SICK COPS DIE

http://www.nypost.com/seven/09062007...k_cops_die.htm

By LARRY CELONA

September 6, 2007 -- Two more cops have died of 9/11-related lung cancer, according to their families.

Officer Frank Macari, 51, died on Monday, after a five-year battle with the disease.

Macari, a 13-year veteran of the force assigned to Brooklyn, developed a tumor on his leg in December 2001, after working at Ground Zero. He leaves a wife and stepdaughter.

Officer Madeline Caro, 41, a 16-year veteran, succumbed to lung cancer in July. Carlo, assigned to the South Bronx, also spent days at the World Trade Center site. She leaves a son and daughter.

Macari's family will file papers, as Carlo's family has done, to obtain line-of-duty benefits from the NYPD.

Meanwhile, the sixth annual NYPD 9/11 Memorial Weekend begins tomorrow with a 1 p.m. parade in lower Manhattan, ending at the police memorial wall at Liberty Street and South End Avenue. The weekend includes a Saturday-night concert at Town Hall in honor of the NYPD's 9/11 victims. It stars tenor Ronan Tynan.

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YOU FUCKING BASTARDS!

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Accuracy of 9/11 Health Reports Is Questioned

http://www.nytimes.com/2007/09/07/ny...nted=1&_r=2&hp

By ANTHONY DePALMA and SERGE F. KOVALESKI
Published: September 7, 2007

Much of what is known about the health problems of ground zero workers comes from a small clinic in Manhattan that at the time of the trade center collapse had only six full-time doctors and a tiny budget.

Dr. Robin Herbert, center, director of the data and coordination center for the World Trade Center monitoring program, with her staff at Mount Sinai.

Yet in the weeks after 9/11, its doctors stepped into the fray in the absence of any meaningful effort by the city, state or federal government to survey, interview or offer treatment to potentially sickened recovery and cleanup workers.

Since then, the clinic, the Irving J. Selikoff Center for Occupational and Environmental Medicine, based at Mount Sinai Medical Center, has examined more than 15,000 workers and volunteers and has overseen the examination of 5,000 more at clinics elsewhere.

Those programs have received more than $100 million from the federal government for tracking and treating those workers. The clinic’s doctors published the largest and most often quoted study of recovery workers’ ills. And they have testified about the health problems before city and federal committees.

But six years after the disaster, it is clear that while the center’s efforts have been well meaning, even heroic to some, its performance in a number of important areas has been flawed, some doctors say. For years after 9/11, the clinic did not have adequate resources or time to properly collect detailed medical data on workers exposed to ground zero dust.

The clinic’s doctors presented their findings in what other experts say were scientifically questionable ways, exaggerating the health effects with imprecise descriptions of workers’ symptoms and how long they might be sick.

Researchers in this field say that the clinic’s data collection was so badly planned that its usefulness may be limited. Others say that doctors at the clinic, which has strong historical ties to labor unions, have allowed their advocacy for workers to trump their science by making statements that go beyond what their studies have confirmed.

Dr. Albert Miller, a pulmonologist who spent more than three decades at Mount Sinai before moving to Mary Immaculate Hospital in Queens in 1994, worries that the actions of the center’s leaders have harmed the legitimate cause of workers who might be in need of help. “They are doing the workers a disservice,” he said, “because any time you veer from objective and confirmable statements, you’re destroying your own case.”

“They are people with a cause,” Dr. Miller said.

Even now, there is debate about how harmful the dust was, and whether it could cause cancer or debilitating chronic diseases, although there is emerging medical consensus that workers who arrived at ground zero early and stayed longest were at greatest risk of getting sick. Medical studies by the Fire Department, and most recently by the city health department, show that the dust has caused diseases like asthma and sarcoidosis (a lung-scarring disease) in a small percentage of rescue workers.

Although the Selikoff clinic’s research has found signs of ill health in more workers than other studies, it generally tracks the same trends. But that has not lessened the skepticism of critics.

The clinic’s leaders acknowledge that their efforts were troubled. But they challenge anyone facing the same hardships to have done better. The doctors point out that they took on ever-increasing responsibilities with federal financing that came in fits and starts. They had to continue their clinical care while collecting data, and clinical care had to come first. They tackled an unprecedented epidemiological challenge with too little money, too few records and too little time to plan properly.

“I’ll accept that we could have done some things better and there’s always room for improvement,” said Dr. Philip J. Landrigan, who has overseen the clinic’s efforts to help ground zero workers. “You have to have a thick skin in this business.”

While organized labor has steadfastly supported and praised the Selikoff Center’s efforts, other doctors say its missteps have heightened the anxiety of New Yorkers who expected the center to answer medical questions that have unsettled the city since 9/11.

There remains confusion about whether government officials should have done more to protect workers from toxic materials at ground zero. The city is still contesting thousands of lawsuits from workers who claim they were sickened while working at ground zero, even as it is providing millions of dollars to Bellevue Hospital Center to treat people sickened by the dust.

And experts agree that the clinic’s imperfect work — done alone and under difficult circumstances — might have long-lasting consequences if the poorly collected data eventually skew the results of future studies. Should the clinic come to conclusions different from other medical researchers, say experts, those contrary findings would confuse the overall health picture, delaying scientific consensus. The city would then have lost valuable time in developing a precise picture of diseases from this kind of disaster and the public health response needed.

Dr. Steven Markowitz, who runs a ground zero screening and monitoring program at Queens College, and who worked at the Selikoff Center in the 1980s, says there is no doubt that the clinic, for all it has accomplished, has also let people down.

“Frankly,” he said, “it was reasonable for the public to expect more.”

End Part I

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A Logical Choice
Forty-eight hours after the attack, Dr. Robin Herbert, Dr. Stephen Levin and other Mount Sinai doctors met at a Westchester County home to figure out how to respond to the disaster at ground zero. They agreed to volunteer extra hours to see sickened workers, and to gather medical information on them. And in the weeks and months that followed, the Selikoff Center was virtually the only place for workers to turn to.

Go to City Room » While federal officials warned those on the pile to protect themselves from the dust, they also said that the chance of developing serious long-term illnesses was low. And city officials stressed that the risk of illness from exposure was minimal. They also faced enormous legal liability if workers on the smoldering pile got sick.

Thomas R. Frieden, commissioner of the New York City Department of Health and Mental Hygiene since 2002, said in a recent interview that the threat of lawsuits in no way shaped the city’s response. Rather, he said, the city did not step in more forcefully because clinical treatment is not one of the department’s responsibilities. But, he said, it was something the Selikoff Center did well.

Few people in New York’s medical community were surprised that the center had taken the lead. After all, the Selikoff Center, named after a pioneering asbestos researcher who died in 1992, was founded in the mid-1980s with political backing from New York labor leaders. It was well known for serving injured union workers, including those with lung diseases, a major concern of Dr. Selikoff’s.

But on 9/11, the center was focused mostly on repetitive strain injuries, the workplace hazard of the moment. Still, ground zero workers complaining of a persistent cough started showing up on Oct. 2. It was not until April 2002, six months later, that the Federal Emergency Management Agency provided the center with $12 million to support a program to give physical and mental health examinations to 9,000 workers.

But the clinic got no money to begin a comprehensive research program, or to make any long-range plans for tracking or caring for injured workers.

“We were told very unequivocally that we were not being funded to do research,” recalled Dr. Herbert, who has been a part of the of the screening program since its inception. “We were being funded to do screening.”

Without money or time to plan, they started collecting data anyway, knowing that it would be necessary to track the rise of symptoms related to dust exposure. But the medical history questionnaire they pulled together was an unwieldy 74 pages long, full of questions that were too vague to be useful. When combined with X-rays and breathing tests, the examination process took more than three hours and scared off many workers. Some of the data was collected on paper and stored in boxes.

“It took me three months just to figure out where the information was and how it had been kept,” said Dr. Jeanne Mager Stellman, a medical researcher who was hired as deputy director of the data center in April 2006. “I don’t think they knew what they were getting into.”

Dr. Stellman resigned last November for personal reasons but continued to work on several mental health studies of ground zero workers. “This is a program that’s done enormous good for 20,000 people,” she said, “but it’s a program that has not yet met expectations.”

The clinic’s doctors also faced significant problems because critical information was simply not available. There were no records of how many people worked at ground zero or for how long. No one knew exactly what was in the dust or how much contamination each person at the site breathed in. And since many workers had not seen a doctor regularly before Sept. 11, there was no reliable way to confirm when respiratory symptoms and ailments started.

By contrast, the New York Fire Department, which monitors its 15,000 firefighters, knew exactly how many firefighters had been exposed. And mandatory annual checkups provided precise medical histories.

It was not until 2004 that the Mount Sinai clinic started to receive federal financing for analysis — about $3 million a year for a data and coordination center. The money was part of $81 million in federal aid for medical tracking — half to cover firefighters, and the rest for ground zero workers.

By then, it was too late to undo some of the missteps made early on.

A Misleading Impression
The Selikoff Center has been criticized for blurring the line between scientific observation and alarmism in acting like an advocate for worker causes. But its doctors say that an aggressive approach is necessary in occupational health because employers tend to challenge complaints about workplace safety.

Go to City Room » “I’ve spent my whole professional life walking that line,” said Dr. Landrigan, who founded the center in 1986 with Dr. Selikoff. “You can collect facts and be rock-solid certain about those facts, but you know quite well that those facts are only a piece of the puzzle. The intellectual question then is: ‘Do I have enough information to issue a call for action?’ ”

Last year, as the fifth anniversary of the attack approached, the center produced a major report that was published in Environmental Health Perspectives, a scientific journal of the National Institute of Environmental Health Sciences, a federal agency. The report said, and Dr. Landrigan declared at a major press conference, that 69 percent of 9,442 responders examined had reported “new or worsened respiratory symptoms.”

In fact, a chart accompanying the report showed that 46.5 percent reported the more serious lower respiratory symptoms, which lung specialists consider to be indications of significant health problems (17 percent reporting shortness of breath, 15 percent reporting wheezing, and 14 percent listing cough with phlegm), while 62.5 percent of the workers reported minor upper respiratory symptoms like runny noses and itchy eyes.

The decision to combine the two categories of symptoms was criticized by medical experts, but it made a powerful — and misleading — impression on the public and the press about the nature and scale of the health problems.

“There is not a scientific reason to lump those two together,” Dr. John R. Balmes, a professor of environmental health and medicine at the University of California, San Francisco, who reviewed a version of the report before it was published, said in a recent interview. “Science is better served separating them.”

Dr. Miller, who called the press conference a “public relations extravaganza,” said: “I’m not as worried about a runny nose as I am about shortness of breath.”

In fact, the 69 percent figure — though it deals with symptoms, rather than actual diseases — suggests a more alarming picture than other studies. For example, a report by the city health department released last week showed that about 4 percent of 26,000 ground zero workers reported developing asthma after working on the pile. And the Fire Department’s sarcoidosis study focused on 26 new cases of the disease since 9/11.

Dr. Landrigan, in an interview, defended the way he presented the findings, maintaining that symptoms like a persistent runny nose could have indicated more serious lower respiratory problems.

The clinic was also criticized for suggesting that the symptoms were longer lasting than their own evidence indicated at the time. No symptom, major or minor, had persisted for more than two and a half years when the study was done, and a condition is not generally considered chronic until it lasts at least five years, doctors say. Yet Dr. Herbert said at the press conference that many workers would “need ongoing care for the rest of their lives.”

Newspapers, including The New York Times, gave prominent play to Dr. Herbert’s statements about the lasting nature of the problems. For some experts, her words went too far.

“It’s very hard to predict the future,” said Dr. Markowitz. “I know people want answers, and I know people want to give answers, but we really have to stick to the scientific method if we want to understand the truth.”

One thing is certain. The press conference galvanized many more workers to seek medical exams. More than 1,000 additional workers signed up for monitoring and 500 new workers continue to enroll each month even now.

Dr. Landrigan said he and his colleagues did not exaggerate their findings to scare workers. But other experts said the doctors may have caused a panic.

“We have patients constantly saying after one of these pronouncements, ‘Am I going to die?’ ” said Dr. David Prezant, deputy chief medical officer of the New York Fire Department, who has overseen several epidemiological studies for the department.

Dr. Prezant said that the Selikoff clinic’s statistics sometimes so worried workers that they neglected proven treatments to seek unorthodox cures that have questionable results.

In what many critics regard as the clinic’s most disturbing recent miscue, Dr. Herbert said in a 10-minute audio interview posted in May on the Web site of The New England Journal of Medicine that she was seeing the beginning of a “third wave” of disease, referring to cancer. In her interview, which accompanied a separate article on ground zero health effects by doctors not affiliated with the Selikoff Center, she named specific types of cancer — leukemia, lymphoma, multiple myeloma — and expressed concern about “synergistic effects” caused by chemicals in the dust, a controversial contention among medical experts.

Go to City Room » She was instantly criticized by doctors outside Mount Sinai, who felt her comments were irresponsibly speculative because there is no evidence yet to conclusively link exposure to the dust to cancer. But the city’s tabloid newspapers seized on Dr. Herbert’s comments, prompting another panic among some recovery workers.

In an interview last month, Dr. Herbert defended her comments, explaining that she was speaking as a clinician and sharing her observations about diseases she was seeing with other clinicians.

“I feel that it is our job to communicate as clearly as we can what we do know, what we worry about, what are possible red flags,” Dr. Herbert said. “We have to strike a balance between not exaggerating and not waiting to act until we have absolute proof.”

Praise From Unions
Today, union officials stand by the work the Selikoff Center has done.

“Sinai should be canonized for the services it is providing,” said Micki Siegel de Hernandez, the health and safety director for District 1 of the Communications Workers of America. “The doctors have really established relationships with responders who walk in. This is the place where workers know that the people care and have the expertise.”

Only late last year did the center and the other clinics begin getting federal money to treat ill workers — $17 million then and more on the way. About 10,000 are now receiving treatment, which generally consists of prescription medication or counseling.

Most days, dozens of ground zero workers make their way to the clinic on East 101st Street. Dr. Jacqueline Moline, who now directs the programs, said some workers show up to be examined for the first time. Others come back to be re-examined. All of them expect answers, but for most, uncertainty has become a constant part of their lives. The center continues to collect data from each of them, and Dr. Landrigan said he expected to publish as many as 10 new reports within the next 18 months.

Eventually, doctors and scientists analyzing the long-term effects of the dust will take into account not only Mount Sinai’s studies but those of the Fire Department, the city’s health department and other sources. Clinical studies will continue for decades.

The Selikoff doctors acknowledge their mistakes, but they do not apologize for speaking out aggressively about the potential health dangers.

“If our advocacy has brought in people and we’ve saved their lives because we’ve identified health problems, whether they’re World Trade Center-related or not, I’ll take that any day of the week,” said Dr. Moline. “And if that’s our epitaph — that we talked loudly and we brought people in for health care — so be it.”
End

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John said that's bunk. Personally, the way it reads, it's almost like a "hit piece."

[Gold9472]

The 9/11 Cover-Up
Thousands of Manhattan residents were endangered by WTC debris—and government malfeasance.

http://discovermagazine.com/2007/oct/the-9-11-cover-up

by Michael Mason
9/7/2007

In the aftermath of the first explosion, the air over Lower Manhattan transformed instantly.

“The sky was glittering with glass,” says Nina L., a Tribeca resident who asked not to be further identified. She ran to her window and saw a shower of flaming jet fuel cascading from one of the towers.

“This can’t be a good thing to have my windows open,” she immediately thought to herself.

Nina closed her windows and shut her air conditioner flues. As a former jeweler, she’d worked around dangerous chemicals before and understood the hazards of toxic fumes. From her apartment seven blocks north of the World Trade Center, she sat transfixed until a second explosion jolted her into action.

Nina tore up an old pillowcase, fashioned a makeshift bandanna over her face, packed her cats into cages, and trekked northward.

“The whole neighborhood was blanketed in a gray snow,” she recalls. “Some people were walking by in moon suits.”

Although Nina could not have known it at the time, she had just entered one of the most dangerous atmospheric conditions ever to occur on American soil, and she suffers the consequences. She had chronic bronchitis until 2003 and still has esophagitis and sinusitis. Many health professionals believe others like her won’t experience the harsher, suffocating symptoms for several more years.

Up to 70 percent of first responders are ill as a result of 9/11 contamination. If a similar rate of illness holds true for those who lived and worked near the Twin Towers, the number of seriously ill New Yorkers could climb to 300,000 in the near future. About 70,000 New Yorkers so far have listed themselves with the World Trade Center Health Registry, a database that tracks the health impact of the 9/11 attacks. The registry has been criticized for excluding large numbers of those potentially sickened outside a designated one-square-mile area. Despite the insistent denials of city and federal officials, tens of thousands of New Yorkers were unnecessarily exposed to a chemical brew without even the most rudimentary precautions. Today New York City is still mired in a fog of cover-ups and half-truths regarding its environmental welfare.

Civil rights attorney Felicia Dunn Jones, who worked a block from the towers, was caught in the initial deluge of dust when the towers fell. Although her family rejoiced upon her return home, Dunn Jones developed a serious cough the following January. She died barely five weeks later of sarcoidosis, an immune disorder caused by toxic exposure. Dunn Jones’s name will be added to the list of victims when the memorial is completed in 2009, and the honor isn’t just a token gesture. The addition of her name is a hard-won acknowledgment that exposure to 9/11 contaminants can lead to death.

David Worby, a personal injury lawyer, is representing more than 10,000 individuals who claim they’ve suffered serious illness as a result of 9/11. Already, 130 of them have died of causes similar to Dunn Jones’s, though Dunn Jones was not a client of Worby’s. Worby is critical of government officials for their overly sanguine assurances about the safety of the air and is especially critical of the city’s lax enforcement of federal requirements that respirators be worn at contaminated sites.

“They are getting sick because of people like Christie Todd Whitman and Rudy Giuliani,” Worby says. Whitman was administrator of the Environmental Protection Agency, and Giuliani was the mayor at the time the towers fell. “My people don’t want their names to be on the wall, because they are not victims of terrorists—they’re victims of bad government. Giuliani should be banned from public office for what he did.”

New York City, the Port Authority, and the contractors who were responsible for the cleanup (Bovis and Turner Construction) are all defendants in the Worby lawsuit.

“I started this suit on behalf of one cop that got sick,” Worby says of his class-action lawsuit filed in 2004. “Nobody would touch the case with a 10-foot pole because it was considered unpatriotic to say anything against the cleanup or the EPA. We have come a long way. They once called the 9/11 cough a badge of honor. Now they know that the whole thing is a catastrophic government disaster.”

Since the attacks, various scientific studies have demonstrated that New Yorkers are engulfed in billows of illness and disease related to 9/11. First the 9/11 cough and mental health problems caught the attention of local doctors. Then chronic respiratory and gastrointestinal conditions began to surface. Recently a program at Mount Sinai noted the emergence of rare blood cancers among 9/11 first responders. Experts predict that more problems will surface in the next few decades.

While the progression of diseases continues to unnerve New York residents, more people are asking why basic health and safety standards were ignored and violated in the wake of the attacks. One nonprofit organization, the New York Committee for Occupational Safety and Health (NYCOSH), keeps a diligent watch on 9/11-related issues.

“The first indication I knew something was wrong was that by September 12 there was no evidence of or even consideration of organization,” says David Newman, an industrial hygienist with ^NYCOSH. Newman was consulting on environmental hazards at 9/11 from day one. “There was no health or safety plan at the site, and this is Safety 101.”

Asbestos was most likely in various construction materials used to build the World Trade Center, an EPA memo stated. It explained that short-term exposure to asbestos can cause respiratory, skin, or eye irritation. The information was dangerously incorrect.

“If our purpose was to save lives and avoid injury and illnesses, we did not have years, months, or even weeks to wait for corrective actions,” said former Occupational Safety and Health Administration chief John Henshaw in a recent House Judiciary Subcommittee hearing. OSHA played an advisory role during the WTC cleanup.

Inhalable asbestos particles are microscopic and completely unidentifiable without the aid of a microscope. Exposure to asbestos is dangerous in part because it does not cause obvious irritation; contamination manifests itself over the course of years and decades, not days. It’s an invisible, deadly, and patient toxin. The only effective protection against airborne asbestos is a special respirator.

“I was down there watching people working without respirators,” Newman says. “Others took off their respirators to eat. It was a surreal, ridiculous, unacceptable situation.”

Stringent protocols govern asbestos contamination cleanup. After a specialized training period, health exam, and certification, licensed technicians must wear industrial-grade respirators and asbestos-resistant suits. New York City has a history of properly addressing asbestos contamination. Back in 1989, a relatively small steam pipe explosion on Gramercy Park South sent 200 pounds of asbestos blowing onto neighboring buildings. As a precaution, the entire building was covered in protective plastic sheeting, and city environmental officials complained that the cleanup would require more than four weeks of painstaking procedures for outdoor decontamination alone. More than 200 area tenants were displaced for weeks following the accident.

The World Trade Center had been, by some accounts, the largest fireproofing project in the world, with possibly 400 to 1,000 tons of asbestos, which was released during the collapse. Bureaucrats aired their assurances to the world.

“The air is safe as far as we can tell, with respect to chemical and biological agents,” Giuliani pronounced two days after the attack.

On September 12, a regional EPA office volunteered to send 30 to 40 electron microscopes to Ground Zero to test bulk dust samples for the presence of asbestos fibers, according to EPA whistle-^blower Cate Jenkins, yet the local EPA office declined the offer, opting for the less effective polarized light microscopy testing method instead. Jenkins had further alleged that regional office personnel were told by the local EPA office: “We don’t want you fucking cowboys here. The best thing they could do is reassign you to Alaska.”

Three days after 9/11, following questionable air sampling techniques, a spokesperson for the EPA said that levels of asbestos were either at low levels, negligible, or undetectable.

End Part I

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“I am glad to reassure the people of New York and Washington, D.C., that the air is safe to breathe and their water is safe to drink,” Whitman said one week after 9/11.

Under the gray, noxious air, trusting residents returned to their homes in Lower Manhattan, unsuspecting children returned to their schools, and hundreds of thousands of downtown workers trudged to their desks. In the following year, the EPA gave more than 50 public assurances concerning the toxic exposure. At least another 15 came from New York City officials.

The systemic failures began occurring almost immediately following the disaster, in part because of an unclear chain of command. In times of environmental crisis, a blueprint for a federal response, called the National Contingency Plan, entitles the EPA to oversee safety and cleanup efforts—but it does not obligate the EPA to do so. During 9/11, New York City initiated a lead role in the environmental crisis response, and as a result, the mayor’s leadership has been called into question.

“We didn’t have the authority to do that [health and safety] enforcement, but we communicated that to the people who did,” Whitman said in a 60 Minutes interview. “Really, the city was the primary responder.” Whitman’s office repeatedly declined an invitation to speak with DISCOVER.

At a time that demanded clear thought and action, a brazen can-do attitude emerged from the rubble, and nobody embodied the reactionary spirit more than New York City’s mayor.

“You smell it, and you feel there must be something wrong,” Giuliani said. “But what I’m told is that it is not dangerous to your health.” Days later he encouraged New Yorkers to “go back to normal.”

Once praised for his heroic response, Giuliani has now made New York City vulnerable to a billion-dollar lawsuit that addresses many haphazard health violations that occurred under his watch. Fewer than 30 percent of Ground Zero workers, for example, wore respirators. After repeated phone calls and e-mails, Giuliani would not return calls or send comments.

The president’s 2002 proposal establishing the Department of Homeland Security addressed the lead-agency issue in the event of future crisis as follows: “After a major incident, the EPA will be responsible for decontamination of affected buildings and neighborhoods and providing advice and assistance to public-health authorities in determining whether it is safe to return to the areas.”

Nevertheless, a lengthy 2003 report (pdf) from the EPA’s Office of the Inspector General (OIG) hammered the EPA for not fully utilizing its abilities, for making uninformed assurances to New Yorkers, for not taking a proactive approach, and for deferring the onus of environmental decision making to ill-prepared New York City officials.

With NYC officials and local landowners left to head up sampling and cleaning facilities, a number of private interests could easily sway air-testing results. An opportunity for collusion exists between the city and landlords: If buildings were found contaminated, property owners could lose millions due to asbestos-blighted buildings, devaluing one of the most lucrative real estate locations in the world. It was in the financial interest of Manhattan’s most wealthy citizens to see their properties up and running at capacity again.

Initially, the New York City Department of Health (NYCDOH) took the lead in implementing an indoor cleanup program, which placed the responsibility for asbestos removal directly on landlords and residents themselves, in direct violation of city, state, and federal laws and at an enormous potential health risk.

Nina, for example, returned to her Tribeca apartment a week after 9/11. She found the entire place salted with what appeared to be a fine coating.

“This stuff goes through clothes, cracks, everything,” says Nina.

In the mail, she received a letter from the NYCDOH instructing her how to clean her apartment: Use a wet rag and use a High Efficiency Particulate Airfilter vacuum. (A study cited in the EPA’s OIG report shows that most residents failed to follow cleaning instructions appropriately.) Only trained, respirator-equipped professionals should conduct asbestos cleanup. Shortly after returning to her apartment, Nina developed crippling headaches and respiratory problems—troubles she never had before.

Eventually, in May 2002, the EPA reclaimed the initiative for indoor air cleanup. It offered a more involved testing for contaminants, but it still did not adhere to the minimum criteria for protecting human health under the EPA’s own guidelines for a Superfund site. As a result, the cleanup efforts received little public trust. In the first cleanup attempt, 4,166 entities had registered; only 295 residents and building owners participated in the second program. Outdoor air sampling and cleaning was another matter.

“Our rooms were microcosms for what was going on in the neighborhood,” Nina says.

A toxic cloud composed of industrial waste and human remains crept out from the aching, smoldering pit at Ground Zero and wound its way into the adjoining streets. Its vapors circled around and up buildings, pumped in and out of nostrils, mouths, and lungs, and stung the eyes of every woman, child, man, bird, and beast within a wide range. It spread itself on building walls and inside boiler rooms and left its trail on parked cars, handrails, and public benches. That day, New York City was blinded by a perpetually sickening haze. It poisoned the minds of politicians who acted with hubris and paranoia. It obscured the vision of responders and residents, many of whom acted with heroism and reckless bravado, never thinking that their actions might be endangering themselves, their families, their cities, and their very future. The cloud billowed southward, over the river, enveloping everything in the dust and debris of blown-apart lives.

Teroy Canfield, now a music producer in Tulsa, Oklahoma, was a student at the Institute of Audio Research in Manhattan in September 2001. On the day of the attacks, he remembers getting a “light dusting” following the collapse of the towers. Several hours later, he joined thousands in their exodus across the Manhattan Bridge toward Brooklyn.

When Canfield returned to his apartment near Clark and Henry Streets in Brooklyn Heights, loose papers and other debris were blowing across the area. His home was in the path of the cloud but supposedly far from the designated danger areas.

“There was dust on our air-conditioning units and on the vents,” Canfield recalls. “When we turned it on, the dust would blast into the room. We had wet bandannas and T-shirts, and we would put them on our faces when we went to sleep.”

Canfield couldn’t decide which was worse—to suffer the heat, to have an air-conditioning unit blowing dust into the room, or to open the windows and endure the noxious odors that were creeping their way into Brooklyn. More often than not, they chose to run the air. As Canfield explains, he simply thought the dust was just dust—skin cells, fibers, whatever.

In the following week, Canfield noticed that his dorm room rapidly collected an inordinate amount of the gray stuff, which prompted him and his roommate to clean the place three separate times that week. Neither of them had heard of, nor followed, any precautions. School had already resumed, and nobody there seemed to be talking about toxins or asbestos, so why worry, he thought.

About six months later, Canfield developed a catch in his throat.

“It was like if you swallowed a piece of rice and your instinct is to hack,” he said. “A dry, hard hack. I might cough three or four times a day, or a week.”

Every so often, the hacking would yield a small clump of tissue—different from phlegm or anything else Canfield had ever seen.

“It was sometimes brown and pinkish-bloody,” says Canfield, who has never smoked. “It didn’t hurt, so I figured it would go away.”

Canfield says that he no longer coughs as frequently as he used to, but he has developed a breathing sensitivity. Ordinary smoke from indoor cooking or an outdoor barbecue seems to bother him the most.

“Some people were buried in the dust,” explains Noah Green^span, a cardiopulmonary specialist at the Pulmonary Wellness and Rehabilitation Center in midtown Manhattan. “There were a lot of toxins in the air, a lot of things that are very hard to clean out of the lungs, things like fiberglass and asbestos. If you inhale those things in large quantities, it’s very difficult for the body to recover from that completely.”

Greenspan has conducted a number of breathing tests on New Yorkers and expressed concern that many people don’t know that pulmonary rehabilitation is a helpful treatment option. He explained that some victims won’t even show any signs of disease for years.

“Smokers can smoke for 25 years before they become symptomatic,” he says. “I think we are going to see a similar trend for people who were exposed to 9/11.”

No agency has tracked the number of former residents like Canfield who have since left New York and fanned out across the globe, nor is there an agency outside of state lines devoted to meeting their health-care needs. At best, former residents are advised to download a treatment guideline from the NYCDOH Web site and pass it on to their doctors. Canfield, who has no health insurance, tells me that he doesn’t plan on seeing a specialist anytime soon.

“I just treat myself if I have to—just eat some soup and my veggies, you know?” he says. “I don’t have money to go to a doctor.”

Even those who conducted air sampling in 2001 have suffered. While the EPA was conducting its own measurements, outdoor air had to be tested for radioactive materials, too, and that required the help of an elite group of government scientists from the National Nuclear Security Administration (NNSA).

Before 9/11, Steve Centore ran four miles a day, led an active family life as the father of three boys and a daughter, and held a security clearance earned from more than 25 years in government service. As a physicist with NNSA, he was among the first sent onto the scene following 9/11. The New York City Department of Health asked Centore to conduct air sampling at Ground Zero, but when he showed up at their makeshift command center on Chambers Street, the NYCDOH simply handed him a hard hat and a painter’s mask and told him to get to work.

“We weren’t worried about contamination, and we were told we didn’t need respirators,” Centore says. Even though he was a scientist, he still had to rely on the EPA’s findings for his own safety.

Centore spent the next four months working among the steaming ruins, looking for radioactive material in both the pile and the debris being carted off to various sites. The radioactive air samplings came back negative—he claims everything had been burned up and swept into the air.

Centore didn’t think much about the cough he had developed until several months later, when it got so persistent that he ruptured a blood vessel in his upper torso.

“It turned half my chest black and blue,” he says.

The bruise initiated a succession of doctor’s visits, but with little relief. By 2005 Centore was a different man—not just physically but mentally. He could no longer exercise, and he seemed detached much of the time. His list of medications steadily increased. For the first time in his life, he began drinking heavily. His wife began to take notice of strange behavior.

“She would find me in the middle of the night standing in the driveway, wearing my pajamas and shaking,” Centore says. A psychiatrist gave him a diagnosis of post-traumatic stress disorder and put him on psychotropic medications for his panic attacks. He took a leave of absence from work, knowing that he would probably never return.

By the spring of 2006, however, a more serious set of symptoms emerged. Centore’s organs began deteriorating. First his gallbladder failed him, then his spleen and liver began to malfunction. He would require a liver transplant eventually.

“I started bleeding everywhere—out of my ears, mouth, penis, and anus, and none of the doctors could figure out why,” Centore says. “I was in the hospital for four weeks, and I can’t tell you how many colonoscopies I had in that time.”

When Centore asked the doctors if he could leave the hospital after four weeks’ worth of testing, he was surprised by their answer. Centore had been moved to number one in line on the liver transplant list, and doctors told him that he might only have hours to live. A liver was harvested in time, and Centore survived the operation. It has taken him a while to be weaned down from 34 daily medications to only 19, but he’s grateful he has his life. Although he believes his health problems are related to 9/11 contaminants, he no longer holds grudges.

“Every once in a while I still have panic attacks,” Centore says, “and I go to the doctor all the time, at least once a week. I am not out of the woods by a long shot.”

Heat up a ballpoint pen, a computer, an office sofa, electric wire, or any other object you might find in a high-rise and there comes a point when you can inhale it. The Twin Towers contained tens of thousands of computer terminals, each housing about four pounds of lead, and an untold number of fluorescent bulbs that contained mercury. Released metal particles from the smoldering pit of the World Trade Center were so fine that they could easily slip past a paper face mask and reach deep into lung tissue, where they are poorly soluble in lung fluid. Metals and glass can remain trapped there for long periods of time and make their way into the heart.

Though the list of known toxins released into the air keeps expanding, it doesn’t deter the ongoing investigations of Thomas Cahill, a professor of physics and atmospheric sciences at the University of California at Davis. Cahill has led some of the most exhaustive scientific studies of 9/11-related toxins, and he has discovered a large number of health-threatening substances from air samples taken in the weeks and months after 9/11.

End Part II