Someone Who Enjoys Their Work

I ran across this interesting profile of Thomas Cahill at University of California, Davis in Esquire magazine (in 1979, I graduated from the Environmental Toxicology program offered by UCD). Dr. Cahill leads the DELTA (Detection and Evaluation of the Long Range Transport of Aerosols) Group and led a key study of air quality at Ground Zero following the World Trade Center disaster. He was later quoted as saying,

"[t]he debris pile acted like a chemical factory. It cooked together the components of the buildings and their contents, including enormous numbers of computers, and gave off gases of toxic metals, acids and organics for at least six weeks,"

and had expressed the conclusion that the conditions would have been "brutal" for people working at Ground Zero without respirators and slightly less so for those working or living in immediately adjacent buildings, which was dramatically at odds with EPA’s finding at the time that the air was safe to breathe just days after the disaster. There was actually no evidence to support such a claim at the time (the White House had put EPA up to it to get Wall Street back up and running, according to EPA’s Office of Inspector General).

The story in Esquire was about a messenger bag owned by Eric Gillan, who was in Manhattan on September 11, 2001. He ran for his life as the first tower fell, then

[a] block into my escape, I made the same decision that got Lot's wife into trouble: I looked back. A twenty-story debris cloud loomed behind me like something Godzilla would fight, and before I could blink or close my gaping mouth, the cloud hit me like a swarm of gravel bees. I was in it and it was in me.

In a few seconds, the sky soured from a pristine blue to yellow to brown to a profound black. Day turned to night. The sky vanished. I stood there in the darkness, my eyes on fire as grit and sand worked its way under my eyelids and into my nostrils, where I got my first whiff of September 11--eau de construction site, with hints of sweet burning plastic and notes of Jiffy Lube. I was being buried alive, right there in the middle of Liberty Street. For five minutes, I gasped for air, but my lungs would not fully inflate, because this was not air. I would've had better luck taking a handful of dirt and inhaling that.

Eric’s messenger bag essentially collected a grab sample of WTC aerosol moments after the disaster. Dr. Cahill:

"This is so exciting," he says to me, actually rubbing his hands together. "We have no other samples from September 11 except your backpack. It will give us a snapshot of what people were actually breathing, which will help the doctors enormously in knowing what to treat." He told me this over the phone, before I arrived from New York to witness the opening. Now, even with me standing there, one of the people who breathed in whatever he's about to discover, he repeats it. Exuberantly. "I'm sorry for you," he says, and he means it. "But I'm also delighted!"

The story was intriguing for me by showing the point of view of a non-scientist watching a scientist at work.

Oh, the dust in his messenger bag? Dry wall gypsum and concrete. Dr. Cahill assures him that the long term respiratory health risks were probably relatively low. So, it probably wasn’t as enlightening as all that.

When Cahill's done, I have a weird thought: Good news! About September 11! Not a lot of people can say that. I hang up the phone and decide to go for a little run around the outside of the building. It's approximately 20 degrees outside, but I'm too excited to sit behind a desk and get on with my life just then. The bogeyman is out of my closet. I'm not one of those people who is going to get sick from September 11 after all. Not yet, anyway. Sure, there are some things we don't know and may never know. Like the kids who grew up at Love Canal or under high-tension power lines, I might wake up in a few years with some unexplainable sickness, some crippling respiratory illness. What are you gonna do? For now, all I want is to feel the air rush in and out of my lungs.

As we know now, the story is different for a lot of people. According to a recently published report of the medical surveillance, approximately 40,000 rescue and recovery workers were exposed to dust and toxic pollutants following the 11 September 2001 attacks on the WTC. These workers included first responders, construction, utility, and public sector workers. Many of these workers, who were at Ground Zero for days, weeks or months without respiratory protection, have experienced long term respiratory symptoms (known as “World Trade Center cough”) and pulmonary function test abnormalities that persisted years after the attacks.

Phthalates and Obesity

Awhile back, the news cycle was all atwitter about this paper published in the International Journal of Obesity. I had posted about it over on Daily Kos last year, to a lukewarm response (political blogs aren’t really in to environmental health, I guess).

The investigators begin by observing that the relationship between obesity and The Big Two, their term for inactivity and inbalanced diet is based on presumed mechanisms and "ecological studies". An ecological study is a type of epidemiological study that examines broad trends in environmental factors and disease; it is not designed to examine specific relationships between exposure and disease, and is considered more useful for generating rather than testing scientific hypotheses. Food industry apologists use this fact to cast doubt on the relationship between diet, exercise and obesity. The investigators argue this doesn't disprove that relationship, but points to the need to look for other factors to help explain the obesity epidemic.

One of the arguments they explored is the relationship between exposure to endocrine disruptors and increased adiposity. The relationship between endocrine disruptor exposure and obesity is an active area of environmental health research. Last year, I posted about a paper exploring the relationship between exposure to the plasticizer bisphenol-A and insulin resistance in mice, occurring at fairly low levels. More recently, a paper has been published describing the relationship between phthalate exposure, girth in males and insulin resistance.

A bit about insulin resistance. Insulin is a hormone that is released from the pancreas after eating. It signals insulin-sensitive tissues, principally muscle, to absorb glucose, which correspondingly reduces blood glucose levels. In an insulin-resistant individual, the normal levels of insulin secreted do not signal cells to absorb glucose. Years of hyperglycemia, from excess carbohydrates in the diet, are thought to disrupt the release of insulin, resulting in glucose intolerance and subsequently Type-2 diabetes. The mechanism for this phenomenon is not entirely clear, and it has not been fully resolved If this loss of pancreatic function results primarily from excessive secretion of insulin (exhaustion of beta-cells in the pancreas) or toxicity to beta-cells (hyperglycemia or other causes). More recent research seems to point to the latter.

Insulin resistance is part of the metabolic syndrome that includes central obesity, elevated insulin secretion, and elevated fatty acids in the bloodstream. Central (visceral) obesity elevates levels of free fatty acids in serum, which might provoke insulin resistance and disrupt lipid metabolism. Testosterone can reduce body fat and increase insulin sensitivity in men, which is where phthalates come in to the picture. Phthalates have been shown to be antiandrogenic agents in male laboratory animals, disrupting testicular steroid hormone synthesis and reproductive function. Some observations suggest that anti-androgenic effects also occur in humans. These investigators were evaluating the hypothesis that increased phthalate exposure would be associated with increased abdominal obesity and insulin resistance, which correspondingly could be precursors to Type-2 diabetes and cardiovascular disease.

The short answer from the study was that concentrations of several prevalent phthalate metabolites showed statistically significant correlations with abdominal obesity and insulin resistance. The authors caution that phthalate exposure only explains some of the variability in measurements of girth and insulin resistance, which they chalk up to obesity being a complex, multi-factorial syndrome (critics may conclude this means there’s no meaningful relationship between phthalate exposure and obesity. . . ). The authors also caution this is a snapshot in time (i.e. a cross-sectional study), and that longitudinal studies (which follow trends over time) are needed to better understand the possible relationship between phthalates and insulin resistance. Other factors to consider in judging the significance of phthalate exposure in metabolic diseases such as diabetes include cumulative exposures to multiple phthalates and exposures to other common contaminants including bisphenol-A, PCBs, dioxins and organochlorine pesticides.

The Washington Post has a reasonably carefully worded article about this issue. Sadly, most other newspapers are mangling what is actually a fairly carefully worded study.

Phthalate exposure isn’t going away any time soon (that’s a story for another day), so what do you do about this? Well, we still have control over the Big Two – diet and activity level.

California Phases out Perc for Dry Cleaning

As long time Impact Analysis readers (all five of you) know, I was on a tear for awhile about perchloroethylene used in dry cleaning (see here, here and here). Perc is the backbone of the dry cleaning industry, which is filled with low-income small businesses. Yet at the same time, dry cleaning is a pathway for exposing millions of Americans to low levels of perchloroethylene. Perc is probably carcinogenic in humans, but at the same time, an apparently relatively low potency carcinogen. However, even a low-potency carcinogen that most everyone is exposed to represents an environmental health matter warranting further scrutiny.

The California Air Resources Board has cut through all of the handwringing, and has amended the Dry Cleaning Air Toxics Control Measure to phase out perchloroethylene use by 2023. The phase-out would happen gradually, replacing the older, less efficient machines first. A training program also will be implemented to have trained operators of dry cleaning machines in all shops in the interim.

According to the ARB’s Initial Statement of Rulemaking, the individual risks from perchloroethylene exposure from dry cleaning emissions was not large – the highest estimated lifetime cancer risk was 75 in a million, for someone located 20 meters downwind from a shop with an older, less efficient dry cleaning machine which emitted higher levels of perc (keep in mind that someone generally doesn’t spend their lifetime at this one location). This risk estimate doesn’t include the doses that dry cleaning customers receive through offgassing from bringing home freshly dry cleaned clothes, a source of exposure that’s potentially more significant.

There’s the usual whining about businesses – in this case, small businesses – being hit harder by a perc ban. However, dry cleaners historically have made the shift from flammable petroleum hydrocarbons, to hepatotoxic carbon tetrachloride to perchloroethylene. In addition, the state appears to be making an effort to assist the industry in converting over to other cleaning agents. Some make the argument that the health risks from perchloroethylene are slight and do not warrant a ban on its use. That’s a point that will continue to be debated, but state, federal and international authorities appear satisfied that perchloroethylene is a probable human carcinogen, and there’s evidence that exposure to it is widespread. Eliminating it from dry cleaning can reduce that exposure. There is a more important issue, though. Perchloroethylene (PCE) in dry cleaning is a poster child for the cause of finding alternatives to toxic chemicals in commerce, in today’s market-driven environment. As a society, if we can’t summon the collective will to solve the problem of implementing lower-risk fabric care products in place of PCE, we’re going to have real problems dealing with other widespread substances with health concerns, such as phthalates or bisphenol-A.

So, let’s hear it for the state of California. Once again, it’s an example of a state blazing a trail where the Federal government (particularly under younger Bush) fears to go.

Don’t Send an Attorney. . .

. . . to do a scientist’s job. I have no doubt that the staff of the Environmental Integrity Project are fine environmental attorneys. Just a reminder though: emissions do not correspond to exposure or risk. More on this later, because now I have to go through their refinery carcinogens report and line it up with the National Air Toxics Assessment and the Urban Air Toxics Monitoring Program. Be back soon.

New York State’s Going to Get Healthy

This week, New York state Governor Eliot Spitzer today announced the initiation of a program make New York the healthiest state in the nation. This is going to be accomplished through a comprehensive disease prevention program.

“For years, the health care debate has focused almost exclusively on institutions that deal with various health problems, such as HMOs, hospitals and nursing homes,” Governor Spitzer said. “By shifting focus to the prevention of disease, we can significantly improve public health and help bring exploding health care costs under control.”

AAAUUGH, I can’t see – I was just hit by something blindingly obvious.

As the writer of an environmental health blog, it is very gratifying to hear the announcement of a state sponsoring a disease prevention program. I wish them luck. It’s something that probably needs to be done. Healthcare reportedly is 16 percent of the economic output of the country, A good chunk of that expense is avoidable suggesting that most people apparently can’t or won’t manage disease prevention on their own. All the Presidential candidates are vaporing about the broken healthcare system – principally from the perspective of how to fix health insurance, though disease prevention and quality of life just don’t seem to enter into the political discussion.

I hope the state of New York can make disease prevention interesting and compelling. There’s something so liberal, earnest and dull about public health. Water treatment and smoking cessation isn’t nearly as entertaining as catching criminals or blowing up terrorists. I wonder if part of the appeal of neocon philosophy has been that sowing war and chaos are more fun than behaving responsibly and spreading civilization, especially if you’ not the one fighting in the war, and you’re on the winning side. Candidates for political office also try to appear tough on crime or strong on national defense, not public health. Telling voters that you’re going to be tough on Type 2 diabetes just makes you look weird.

New York State’s agenda is ambitious, and appears to hit all of the high points:

- New public health campaigns targeting cancer, diabetes, obesity, asthma, stroke and heart disease and depression;

- A new program requiring Body Mass Index reporting in schools;

- New legislation requiring healthier school lunches;

- New anti-smoking initiatives, including aggressively promoting tobacco cessation treatment to all Medicaid, Child Health Plus and Family Health Plus enrollees;

- Expanded access to cervical cancer vaccine;

- Enhanced programs to combat HIV/AIDS in minority communities;

- A directive that all state agencies make the elimination of trans-fat a condition of future food service contracts;

- A new program to improve the quality of provider skills in mammography interpretation, colorectal screening and infection control;

- Implementation of a prenatal/postpartum home visitation program for high-risk communities;

- Expanded use of incentives to encourage physical fitness by state employees;

- Expanded childhood lead poisoning prevention efforts;

- Creation of a new Pollution Prevention Institute in the Department of Environmental Conservation to assist businesses in reducing the use of toxic chemicals;

- A new “Green Cleaning” initiative that will help reduce exposure to harmful chemicals in state facilities, schools and worksites; and

- Administrative directives encouraging the use of non-toxic pest control at state facilities, schools and other institutions.

In addition to these disease prevention and environmental measures, the agenda also includes a concerted effort to address infection control in hospitals and nursing homes and other institutions. This effort includes stockpiling of anti-viral medications and public health emergency preparedness exercises across the state.

Funding for the initiatives is reportedly more than $200 million. The governor’s 2007-2008 budget proposal also includes expansion of a program to provide affordable health insurance coverage to the uninsured in the state.

Expect the usual conservative wingnut blogger allusions to food fascism and anti-smoking Nazism. Some of the wingnuttery have even directly compared health promotion advocates to the Nazis.

An agenda is one thing – implementation is another. There will need to be some out-of-the-box thinking to keep this from turning into another juiceless, marginally effective government program. One possibility might be to give it a social marketing spin. There’s more on social marketing as a tool for health communications here and here. I’ve written before about a program sponsored by New York City that appeared to be working for helping diabetics manage their diet, exercise and meds, that is, before the clinics went out of business. More money to be made in amputations than nutritional counseling. . . . Anyway, the story in the New York Times chronicled a client of the program, who was slipping back into her high-risk habits, without the support system provided by the clinic. Perhaps these clinics were providing a social network beyond the medical supervision. Maybe there will be a few dollars to start them back up again, Governor Spitzer?