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The Legacy of World Trade Center Dust, by Jonathan M. Samet, M.D., Alison S. Geyh, Ph.D., and Mark J. Utell, M.D., The New England Journal of Medicine, Volume 356:22:2233, Number 22, May 31, 2007
http://content.nejm.org/cgi/content/full/356/22/2233
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. In addition to the matter of the immediate and persistent respiratory effects on "first responders," occupants of the towers, cleanup workers, and neighborhood residents, concern has arisen about longer-term risks, including the risk of cancer. The level of concern with regard to the respiratory effects of the disaster may well be compounded by the psychological consequences. Already, some responders have received compensation, and litigation is in progress for thousands of people with alleged illnesses caused by inhaling the dust.
Subsequently, the smoke and dust from fires and resuspended debris and the engine exhaust from cleanup equipment and vehicles were major sources of airborne contaminants.1 Because air was not sampled immediately after the disaster, data are lacking on the identity of the contaminants and their concentrations in the plume at that time. Photographs showing a dense cloud at street level imply that the concentrations of particles in the air must have been on the order of milligrams per cubic meter — orders of magnitude greater than typical ambient levels. Analyses of settled dust samples revealed the presence of combustion-related carcinogens, building materials, and some asbestos. The samples were dominated by larger particles, which settle more quickly than smaller ones. The smaller particles, which can penetrate into the deep lung and would have been generated by burning materials, were probably not captured in these samples.
Soon after the disaster, agencies and academic institutions implemented monitoring for particles, volatile organic compounds, polychlorinated biphenyls, and dioxins and metals associated with particles. The composition of the mixture changed as debris removal progressed and as fires were extinguished. Analyses of archived filters for carcinogenic polycyclic aromatic hydrocarbons (PAHs) indicated very high concentrations from fires in the early days and lower levels later, probably from diesel engines. In October 2001, samples collected from streets bordering the disaster site showed high concentrations of particulate matter less than 2.5 ìm in aerodynamic diameter; by April 2002, the median concentrations had decreased substantially.2 Even at far lower levels, exposure to airborne particles in U.S. cities has been linked to premature death and disease. The characteristics of the particles present at the time of the disaster were undoubtedly quite different from those in typical urban air pollution, but without specific estimates of exposure for workers and the population, the risks from these materials cannot be quantified.1
The risks posed by exposure to airborne particles depend on the doses delivered to the respiratory tract. Particle size is also key: particles larger than 5 ìm are effectively filtered out by impaction in the upper airways, unless concentrations are high. Smaller particles penetrate the lungs, and nanosized particles generated by combustion can be deposited throughout the respiratory tract. It is likely that particles of all sizes were initially present in the dust at very high concentrations that decreased over time.1 A biomonitoring study of firefighters suggests that they may have received substantial doses of larger particles.3 Analysis of induced sputum collected from involved firefighters 10 months after the disaster showed a significantly higher percentage of large mineral particles than that found in a comparison group of firefighters from Tel Aviv. Irregularly shaped particles were seen in epithelial cells and alveolar macrophages, and their mineral content, unlike that in the comparison group, included such elements as gold, tin, and titanium. A correlation was reported between the estimated level of exposure to this dust and markers of inflammation in the firefighters.
Little is known about the extent to which the workers and the general population were exposed to the potentially toxic gases generated by combustion, such as dioxins. An analysis of 110 chemicals in blood taken from firefighters in early October 2001 showed elevated levels of 5 chemicals.4 This study showed that firefighters at the site received elevated doses of some PAHs, which suggests they may have inhaled other combustion carcinogens.
Controversy continues concerning the extent of asbestos exposure among workers and the general population. The Environmental Protection Agency collected thousands of samples of airborne and settled dust and analyzed them for asbestos content. The majority of samples had an asbestos content below the clearance threshold used for schools. Some workers at the site probably inhaled asbestos fibers, particularly if they were not wearing protective equipment. The level of asbestos exposure among people living and working around the site was probably lower and is unlikely to have been sufficient to cause asbestosis or a measurable increase in the risk of lung cancer. Although such exposure might slightly increase the risk of mesothelioma, any excess would not become evident for decades.
The initial assessment and follow-up of firefighters have shown that a syndrome described in the Journal in 2002 as "World Trade Center cough" developed in some firefighters and that exposure was associated with a substantial and probably permanent loss of lung function. Physiological testing of exposed firefighters about a month after September 11 showed that the level of bronchial hyperreactivity in those who were on site the morning of the disaster was three times that in those who arrived later but within the first 2 days. Pulmonary instillation of World Trade Center dust into mice also induced bronchial hyperresponsiveness.1 The clinical picture in the firefighters is consistent with that of reactive airways disease, which can develop after high-level — and often brief — exposure to inhaled irritants. Follow-up of firefighters during the year after the disaster showed a reduction in lung function about 10 times as severe as that predicted for a single year of aging — a drop of approximately 320 ml in the forced expiratory volume in 1 second, as compared with the normally anticipated drop of 30 ml. Medical monitoring for up to 12 months after the towers' collapse showed persistent respiratory abnormalities in responders.5
The general population would have been exposed to particles and gases when on or near the site on days when the air was polluted by the fires or cleanup activities or when returning to contaminated buildings. Many survivors of collapsed or damaged buildings reported new or more severe respiratory symptoms several years after the disaster. One survey, started 8 months after the disaster, found greater respiratory morbidity and more symptoms among people living within 1.5 km of the site than among those in a control area.1
Some conclusions can now be reached about the World Trade Center dust and its associated risks. First, the dust has been described thoroughly, and uncertainty concerning exposure levels and the characteristics of the mixture will not be reduced. Second, some responders who were at the site in the hours and days immediately after the disaster have persistent respiratory abnormalities consistent with airway injury resulting from inhaled particles and gases. Medical monitoring has been put in place for this group. They were exposed to inhaled carcinogens, but any associated increased risk for respiratory tract cancer and most other types of cancer will not become apparent for decades. Some reassurance can be found in studies of other firefighter groups that have generally not shown a high risk of respiratory tract and other cancers. Third, the respiratory health of the general population, particularly those who were in collapsed or damaged buildings, may have been affected. Synergy among the inhaled pollutants, together with psychological sequelae reflecting the severity of this extraordinary event, may also have contributed to the occurrence and persistence of symptoms.
As people who were exposed to the dust age and develop malignant and nonmalignant respiratory diseases as a result of smoking and other factors, some will undoubtedly attribute these diseases to their exposure at ground zero. The actual causal contribution of the dust to future risk of disease can best be characterized through prospective epidemiologic investigations involving sufficient numbers of exposed persons, along with control groups. A World Trade Center Health Registry has been established and includes survivors of collapsed and damaged buildings in downtown Manhattan and the immediate vicinity of the disaster site; rescue, recovery, and cleanup workers; and students and staff members at downtown Manhattan schools. The registry, designed to track the physical and mental health status of this group of highly exposed persons for up to 20 years, could become the platform for the requisite investigation. Decades of commitment to the registry, as well as continued monitoring of responders, will be needed to gain the best information possible on the longer-term consequences of inhalation of the dust.
Still, there are some things we will never know for certain; indeed, we do not even know with any certainty the size of the exposed population. Continued tracking of the responders should provide a clearer picture of the natural history of World Trade Center cough syndrome and should guide selection of the most effective therapies. The registry will be informative regarding broad questions of health, but although it includes more than 71,000 registrants, analyses of follow-up data will not reveal the existence of relatively infrequent consequences unless the additional risks are very high. The long-term risks of cancer will be difficult to measure with any precision, although quantitative risk-assessment approaches should prove useful for estimating the maximum potential burden of cancer. But even the full suite of research efforts in progress may never provide the evidence needed to answer all the questions that will be raised about the long-term health effects of the events of September 11.
Source Information
Dr. Samet is a professor and chair of the Department of Epidemiology, and Dr. Geyh is an assistant professor of environmental health sciences, at the Johns Hopkins Bloomberg School of Public Health, Baltimore. Dr. Utell is a professor of medicine and environmental medicine at the University of Rochester School of Medicine and Dentistry, Rochester, NY.
An interview with Dr. Robin Herbert, codirector of the World Trade Center Medical Monitoring Program at Mount Sinai Hospital, New York, can be heard at www.nejm.org.
References
1. Landrigan PJ, Lioy PJ, Thurston G, et al. Health and environmental consequences of the World Trade Center disaster. Environ Health Perspect 2004;112:731-739. [ISI][Medline]
2. Geyh AS, Chillrud S, Williams DL, et al. Assessing truck driver exposure at the World Trade Center disaster site: personal and area monitoring for particulate matter and volatile organic compounds during October 2001 and April 2002. J Occup Environ Hyg 2005;2:179-193. [CrossRef][ISI][Medline]
3. Fireman EM, Lerman Y, Ganor E, et al. Induced sputum assessment in New York City firefighters exposed to World Trade Center dust. Environ Health Perspect 2004;112:1564-1569. [ISI][Medline]
4. Edelman P, Osterloh J, Pirkle J, et al. Biomonitoring of chemical exposure among New York City firefighters responding to the World Trade Center fire and collapse. Environ Health Perspect 2003;111:1906-1911. [ISI][Medline]
5. Banauch GI, Hall C, Weiden M, et al. Pulmonary function after exposure to the World Trade Center collapse in the New York City Fire Department. Am J Respir Crit Care Med 2006;174:312-319. [Free Full Text]
The New England Journal of Medicine is owned, published, and copyrigted © 2007 Massachusetts Medical Society. All rights reserved.
Interview with Robin Herbert on the health effects of the World Trade Center dust, Supplement to: Samet JM, Geyh AS, and Utell MJ. The Legacy of World Trade Center Dust. N Engl J Med 2007;356(22):2233-6.
Dr. Robin Herbert is codirector of the World Trade Center Medical Monitoring Program at Mount Sinai Hospital, New York.
Rachel Gotbaum, the interviewer, is an independent producer based in Boston.
The audio interview is available at the website of the New England Journal of Medicine
A Double Nightmare for Officer, by Susan Edelman, New York Post, May 31, 2007
At age 35, Reggie Hilaire was a dad-to-be and beat cop in East Harlem.
"I felt on top of the world," said Hilaire, who'd been with the NYPD for five years at the time.
But his world came crashing down in early 2005 when his pregnant wife discovered a golf-ball sized lump in his neck - thyroid cancer.
Surgery and radiation knocked out the cancer in Hilaire, who says he logged nearly 850 hours digging through WTC debris at the Fresh Kills landfill and patrolling Ground Zero.
But in a checkup late that year, his regular doctor noticed signs of anemia, and referred him to a specialist.
A bone-marrow biopsy showed signs of multiple myeloma, a progressive blood-cell cancer that usually strikes people over age 60.
"This has to be a mistake," the doctor told Hilaire. "First, you don't look sick, and second, you're too young.' "
Hilaire repeated the test two months later, producing similar results, but the doctor called it "benign," pre-cancerous at worst.
A second opinion confirmed he had multiple myeloma without the typical symptoms such as bone pain and kidney failure.
"The good news: it was caught early," Hilaire said. "The bad news: I have a 50 to 60 percent chance for the myeloma to get worse within two to three years."
Hilaire says his second bout with cancer convinced him that 9/11 toxic exposure was to blame.
"Without a doubt," he said. "What are the chances of getting two cancers in a year, and four years after 9/11?"
Copyright 2007 NYP Holdings, Inc.
Doctors tracking WTC illnesses `most concerned' about blood cancer, by Amy Westfeldt, Associated Press, May 31, 2007
http://www.amny.com/news/local/groundzero/ny-bc-ny--attacks-New cancer concerns for 9/11 responders, WABC Eyewitness News, May 31, 2007
http://abclocal.go.com/wabc/story?section=9_11&id=5356926
(New York - WABC, May 31, 2007) - There are new health concerns surrounding 9/11 responders.
Doctors say the responders are getting blood cancers at unusually young ages, and they blame toxins at ground zero.
Eyewitness News reporter Joe Torres is in Lower Manhattan with the story.
Doctors diagnosed 42-year-old former NYPD detective Ernie Vallebuona with non-Hodgkins Lymphoma in October of 2004. Forty two-year-old John Walcott, also a former city detective, learned he had leukemia in May of 2003.
"Maybe if someone took us serious four years ago, more people would've been tested. We wouldn't be talking about autopsies, this and that. More people would've gotten tested," Walcott said.
"I've been on a crazy ride ever since ... chemotherapy, radiation, stem-cell transfer, all types of treatment. It's been tough," Vallebuona said.
According to researchers, more and more relatively young 9/11 first responders now show signs of cancer -- cancer conditions seemingly triggered by their exposure to a wide range of chemicals and carcinogens at ground zero.
"We know we have a handful of cases of multiple myloma in very young individuals and multiple myloma is a condition that almost always presents later in life," said Dr. Robin Herbert of Mt. Sinai Medical Center.
Attorney David Worby, who represents thousands of 9/11 workers, says he warned federal and city officials of these health problems years ago. Now he says it's time for government leaders to do the right thing.
"There are a series of tests that people with a significant exposure need to have. That's got to come from the federal government and the city," Worby said.
(WABC-TV, Copyright 2007)
Years to Figure Dust Effects, by Susan Edelman, New York Post, May 31, 2007
http://www.nypost.com/seven/05312007/news/regionalnews/years_to_figure_dust_effects_regionalnews_susan_edelman.htm
May 31, 2007 -- The full scope of cancers linked to the WTC dust "will not become apparent for decades," a report in the New England Journal of Medicine says.
Dust samples found combustion-related carcinogens, building materials and some asbestos, but mainly large particles. Smaller particles, which penetrate deep in the lung, were "probably not captured in the samples."
9/11 Cancer Cops, by Susan Edelman, New York Post, May 31, 2007
A group of 9/11 responders has contracted blood cancers at an unusually young age, and top doctors suspect the disease was triggered by an unprecedented "synergistic mix" of toxins at the World Trade Center site.
The WTC Medical Monitoring Program is now studying a group of Ground Zero workers, including cops, construction workers and volunteers, suffering from cancers such as leukemia, lymphoma and multiple myeloma.
"The kind of thing that worries us is that we have a handful of cases of multiple myeloma in very young individuals . . . a condition that almost always presents late in life," said Dr. Robin Herbert, co-director of the program at Mount Sinai Hospital.
"That's the kind of odd, unusual and troubling finding that we're seeing already," she says in an interview with the New England Journal of Medicine, which comes out today.
The WTC monitoring program has examined more than 20,000 workers, but so far has focused on respiratory ailments.
The mounting cancers, Herbert said, represent a "third wave" of sickness stemming from Ground Zero exposure. First came immediate breathing problems, then chronic lung diseases.
"We're worried about a third wave, which is the possibility of cancer down the road," she said.
The Post has published several reports on the growing number of 9/11 responders with cancer.
Doctors say a comparison of cancer rates in 9/11 workers with normal rates in the same age groups could prove whether WTC dust and smoke caused an increase.
Attorney David Worby, who filed a class-action suit for 9/11 workers in 2004, said yesterday about 105 of his 10,000 clients have gotten blood cancers, one as young as 30. Most range in age from 35 to 45, he said.
Several have died, including a carpenter and two NYPD cops.
Worby has long argued that a "synergistic effect" - exposure to multiple toxins - weakened the immune system and accelerated the cancer process.
He also explains the early onset of cancer in firefighters, cops and construction workers as a result of "years of prior toxic exposure" in their jobs.
"The argument that these diseases don't happen so fast does not take into account those pre-dispositions," he said. "They've been using the wrong math to calculate the latency periods."
For the first time publicly, Herbert said WTC doctors are "worried about the possibility of synergistic effect."
She said 9/11 workers were exposed to a mix of cancer-causing agents plus an "unbelievable range of other chemicals."
"One of the things that surprised me, and many of my colleagues, is how often we're seeing the so-called zebras, the conditions that we never actually saw in our lives before," Herbert said.
3rd Wave of Ills from WTC Seen: Mount Sinai Docs Fear New Cancers, by Jordan Lite, Daily News, May 31, 2007
http://www.nydailynews.com/news/2007/05/31/2007-05-31_3rd_wave_of_ills_from_wtc_seen-2.html
Responders to the 9/11 terror attacks could face a devastating "third wave" of illnesses - blood and lymphatic cancers - related to their exposure to Ground Zero air, says the director of the largest treatment program for those workers.
Though many scientists have cautioned that it's too soon to link cancers to toxins at the site, doctors at Mount Sinai's World Trade Center medical monitoring program are now seeing surprising cases of plasma-cell cancers in people who were there, said Dr. Robin Herbert.
"We know we have a handful of cases of multiple myeloma in very young individuals, and multiple myeloma is a condition that almost always presents later in life, so that's the kind of odd, unusual and troubling finding that we're seeing already," Herbert said in an online audio interview in advance of today's issue of the New England Journal of Medicine.
Doctors at Mount Sinai are trying to verify cases of leukemia and lymphoma reported by any of the more than 20,000 responders they've examined, she said.
More than 120 people with those cancers are part of a class-action lawsuit alleging negligence by the city and its contractors at Ground Zero, said lawyer David Worby.
"People are afraid of the C-word, cancer. It's taken hundreds of people getting sick this way for Mount Sinai to say, 'We are more than concerned,'" Worby said. "Washington and Mount Sinai should draw up an entire platform of blood tests and precancer tests."
Herbert was unavailable for an interview, but in the Journal she described three waves of post-9/11 illnesses.
The first was the stubborn, dry "World Trade Center cough" stemming from pulverized cement there and seen in the months just after the disaster.
The second wave involves chronic respiratory diseases that cause lung inflammation and scarring.
Cancers could be the third wave among responders exposed to asbestos, dioxins and other carcinogens at Ground Zero, Herbert said.
Although the "full range" of those toxins will never be known, "you really worry when you have a mix of chemicals about the possibility of [a] synergistic effect," she said.
jlite@nydailynews.com
WTC skyscraper work resumes 2 weeks after pipe fell on firehouse, AM New York, May 31, 2007
http://www.amny.com/news/local/groundzero/ny-bc-ny--toxictower0531may31,0,6274504,print.story?coll=am-topheadlines
NEW YORK (AP) _ Work resumed on a damaged skyscraper being taken down across from the World Trade Center site on Thursday, two weeks after a steel pipe fell off the building and through the roof of a nearby firehouse.
The Department of Buildings lifted a stop-work order at the former Deutsche Bank building after the main contractor, Bovis Lend Lease, agreed to more closely monitor the project and to install a sidewalk shed covering the Engine 10/Ladder 10 firehouse and its bronze memorial to the Sept. 11 attacks.
The city still is investigating what caused the 15-foot-long sprinkler pipe to fall off the 40-story building and through the roof of the firehouse, injuring two firefighters.
The work stoppage won't postpone plans to have the building completely taken down by December, its owners say.
"We firmly expect to completely take the building down by the end of the year," said Errol Cockfield, spokesman for the Empire State Development Corp., whose Lower Manhattan Development Corp. subsidiary bought the vacant building three years ago to take over its removal.
The contaminated skyscraper has languished for years at ground zero after lengthy court battles over who should pay to remove it, an ongoing cleanup of toxic materials and the recovery of hundreds of human bones believed to be the remains of Sept. 11 victims.
Reacting to the Death of Felicia Dunn-Jones, by Cynthia Smith, Associated Content, May 30, 2007
http://www.associatedcontent.com/article/257500/will_the_world_trade_center_debris.html
On May 24th, 2007 Chief Medical Examiner Charles Hirsch, finally conceded that it was likely that Felicia Dunn-Jones, a City Attorney, died from complications arising from her exposure to World Trade Center Dust. Felicia's Autopsy report listed her cause of death as sarcoidosis, which is an inflammation of tissue that begins in the lungs but can spread to vital organs. The symptoms started with a cough that developed a few months after the attack. She eventually became weak and the cough got worse. On February 10, 2002, she stopped breathing and passed away.
On May 24, I was watching the news on TV when I saw her picture pop up on screen. I almost went into shock. I knew Felicia-Dunn Jones. From 1990 to 1993, I had worked at the New York City Law Department as a proofreader, where she also worked and I used to proofread her legal documents all the time. I remember her as a nice friendly woman, who never passed on the pressures of her job to the word processing and proofreading staff. I had not been aware of her death until now. I was shocked that she had died. A day later, I am not only shocked, but I am also scared because I too, was exposed to that dust.
On 9/11, I was no longer working at the Law Department located one block away from the World Trade at 100 Church Street. I was working in One World Financial Center, which was right across the street from the World Trade Center. That day, I arrived to work late and got off the train right after the second plane had already crashed into the South Tower. The streets were filled with workers and tourists, who were all gaping at the huge burning holes in the two towers. I spotted one of my coworkers and we both wondered whether we should go on to work. We were standing on Liberty and Broadway, a block away from Church Street, where the towers stood. We had just begun to walk down Liberty towards Church when a police officer made everyone go back to Broadway. I have often wondered if that police officer survived. He probably had not because the buildings fell about 15 minutes later.
My coworker got back on the train and went home. The trains were still running at that time. Like a fool, I remained standing on Broadway, transfixed by the sight of the fires. I looked around and found, what must have been my facial expression echoed on all the faces around me. We were sickened and sad. Some of us were crying. We looked around at the thousands of pieces of office paper lying around the streets. We saw shoes left behind either from people running when the planes hit. We saw debris from the planes.
I am embarrassed to relay the following part. You see, I am a coffee addict. I walked half a block down and purchased a coffee from a deli. I came back to my post on Liberty and Broadway, sipped on my coffee and watched the towers. I imagined that the fires seemed to be dying down. I experienced a sense of relief. I remember turning my head away from the towers for 10 seconds or so. At that time, my life turned upside down.
Right after turning my head, I heard a huge sound. It sounded like a bomb. Immediately the thousands of people who were around me began to run. I had the clarity of mind to dump the coffee before running so that it wouldn't splash on me. It's funny the details we remember. I ran with the crowd and never even had a chance to look back. I did not know what the sound was, but I was convinced that another plane had arrived and was actually chasing us down. The images running around my head were reminiscent of the scene in the Pearl Harbor movie where everyone is running as planes are dropping bombs on them. I remember thinking, "Oh my God. I'm going to die." I was going to die because I lingered instead of going home like my coworker.
After running for about 10 steps, I fell. I quickly got up because I knew that I was not going to get trampled on the streets of Manhattan. I skinned my knee and also bumped my head into a pole. It took me 2 seconds to get up again and I continued to run. I had been running for about 5-8 seconds when I felt something heavy and hot envelop me. Suddenly, I was in darkness. I stopped running. I felt dust and debris rushing at my face and I closed my eyes and mouth, not instinctively, but deliberately. I didn't' know what was happening, but I imagined that a bomb had hit nearby and I was being buried alive. I thought of my kids and I wondered how long it would take for rescue workers to finally dig up my body. I remember thinking to myself, "This is the end of my life. This is the end of Cynthia." I had a sense of calm and inevitability.
Eventually, I opened my eyes a little bit and carefully began to breathe again. The darkness had lifted somewhat and was replaced with the gray haziness, you see in the aftermath of a nuclear explosion. I found myself rasping, "Where are we?" My mind was disoriented and I thought I was buried underground. I heard other people asking the same question. I had forgotten that I had only run about 10 paces and so had everyone else. Eventually we heard a voice that called out, "Over here. There is an opening." We followed that voice to a building door. It was then I realized I was not underground. We went into the building, mercifully found a cart with Snapple and water and we passed it around, washed our faces of world trade debris and rinsed out our mouths and throats.
Eventually, like Felicia Dunn Jones, we found our way home. When I arrived home hours later, I went straight to the Emergency Room where I was interviewed by cops and doctors. I expressed concern about all the debris I had inhaled and the doctor told me I would be fine and that the body would get rid of it little by little. "The body is very resilient," she said.
I have been fine. I have had no physical problems although I did develop panic attacks that lasted for a few months. I still cringe when I hear a plane that is flying too low. However, I can't help wondering if the debris I inhaled will have some physical effect on me. Will I too develop sarcoidosis? Remember how long it took before an association was formed between mineworkers working with asbestos and the cancers they later developed? Will I too become a victim of 9/11 maybe 5, 10, 20 years down the line?
All I can do is smile and hope for the best.
More resources http://www.nydailynews.com/news/2007/05/24/2007-05-24_she_died_of_wtc_poison-5.html
2007 © Associated Content, All rights reserved.
Health Toll of 9/11 Still Unclear, by Amanda Gardner, Canadian Press, May 30, 2007
http://www.cbc.ca/cp/HealthScout/070530/6053008AU.html
It was a disaster that defied all imagination.
And now, more than five years after two jetliners plunged into New York City's twin towers on Sept. 11, 2001, there is much experts don't know and may never know about the health consequences of that unforgettable day.
"The real issue is the uncertainty of what we don't know," said Dr. Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City. "And when you look at what we do know, the question arises as to whether we're looking at tip of the iceberg or the iceberg itself."
The disaster has been associated with a prolonged hacking known as "World Trade Center Cough" and with sarcoidosis, a disease that causes inflammation and scarring in the lungs.
Just this week, the New York City Chief Medical Examiner added the name of Felicia Dunn-Jones to the list of attack victims. Dunn-Jones, a 42-year-old attorney at the time of the attacks, died of sarcoidosis five months after the attacks. This marked the first time the city had officially linked a 9/11 death to the toxic plume.
According to a perspective piece in the May 31 issue of the New England Journal of Medicine, some responders have already received compensation and litigation is ongoing for thousands of people who allegedly fell ill after inhaling World Trade Center dust.
The article, by researchers at Johns Hopkins School of Public Health in Baltimore, outlined what is known and unknown about the medical fall-out of 9/11.
"We know that people were exposed to a very large, high-concentration cloud of dust which would be particles and gases in the air, especially on Day One right after the disaster," said Alison Geyh, co-author of the paper and an assistant professor of environmental health sciences at Johns Hopkins Bloomberg School of Public Health.
Scientists even have some insight into the composition of that dust, although this comes from an analyses of samples collected on the ground, which may or may not be the same as what was hovering in the air. Air was not sampled immediately after the disaster, for obvious reasons.
Generally, the range of contaminants in those samples was not surprising and included combustion-related carcinogens, building materials and some asbestos, a known carcinogen.
Samples collected the month after the disaster found high concentrations of particulate matter less than 2.5 micrometers in aerodynamic diameter. Size is a key component of risk, with smaller particles more able to penetrate the lungs. Samples that were taken from the sputum of firefighters who responded to the emergency showed gold, tin and titanium.
"It's the particles smaller than 2.5 micrometers that are inhaled and really get deep into the lungs," Horovitz explained. "When that happens, there are a bunch of consequences."
But there's more that experts just don't know.
"The big, big, big question is how concentrated was that mixture in the air on the day the buildings fell down," Geyh said. "It would be really helpful to us to know what the concentrations were that day but nothing was working, obviously, that day so we'll never know that. We will never exactly know what airborne concentrations were directly on the site across the entire time period people were there."
Researchers will also never know how many people were exposed. "We're never going to know how many people were exposed and that makes it difficult to quantify the extent of the potential health problems," Geyh said.
Nevertheless, the people who definitely were exposed need to be followed for the next decade or even two decades, Geyh said. "We need to follow them into the future to document what happens to their health," she said. "We're not saying that there is a problem or isn't a problem. We just need to make sure we know what is happening with these people and if we understand what is happening with this well-defined group, it will make it easier for other people who feel like they're having problems related to exposure."
© The Canadian Press, 2007
Expert Says Workers Could Be Exposed to Asbestos in Greensburg Clean-Up, Associated Press, May 30, 2007
http://www.insurancejournal.com/news/midwest/2007/05/30/80194.htm
A Kansas asbestos expert says he is so sure that residents and volunteers who are wading through what's left of Greensburg, Kan., are being exposed to the carcinogen that he's willing to wager his reputation on it.
"I don't like to assume anything ... but it's more likely yes than not'' that there is asbestos in the debris, said Leland Sumptur, a Lenexa, Kan., asbestos abatement manager who teaches and has consulted nationally. "I would almost stake my job on it.''
But federal environmental officials say if there is asbestos in the nearly 1,000 private residences that were destroyed in a May 4 tornado, there's really nothing they can do about it if air samples don't indicate a problem.
Government regulators acknowledge that the housing debris could be contaminated with asbestos, but they haven't seen any proof.
Many of the homes in Greensburg were built before 1980, when construction materials frequently contained asbestos, which is dangerous when inhaled or ingested. Some experts say because of the danger, the government should be doing more to protect the health of those helping in the cleanup effort.
"It's a shame, because people are out there and most likely getting contaminated,'' Sumptur told The Kansas City Star.
Becky Ingrum Dolph, an attorney for the Environmental Protection Agency, said regulators don't have the authority under federal and state regulations to require asbestos be removed from single-family homes.
She said the government has done everything it legally can to protect residents and volunteers.
Two weeks after the tornado destroyed 961 homes, caused major damage to 105 more and minor damage to 67 others, the EPA took eight air samples in and around Greensburg to see if asbestos fibers were in the air. The samples came up negative.
If the tests had been positive, that would have meant there was imminent danger to human health and the EPA would have been allowed to take action, Dolph said.
Without the positive samples, she said, "Legally, we don't have any authority to require the individual homeowner to do anything.''
But air samples alone aren't good enough, experts said.
"For someone to suggest they did air sampling and they didn't find anything, that is so wrong to do that,'' said Celeste Monforton, a public health policy researcher and lecturer at George Washington University. "It gives some people a false sense of security.''
As chief of the Mine Safety and Health Administration's health division, Monforton has been involved in cases dealing with asbestos and miners.
"Really the risk is going to be to the people rummaging through the debris and what they are breathing there,'' Monforton said. "For someone walking down the street it might not be such a problem.''
But EPA officials said suspicion of contamination is not enough to warrant testing the debris.
Days after the tornado, licensed asbestos workers tested commercial buildings and schools and determined that four, including the high school, contained asbestos. Those buildings have been cordoned off and posters have been taped to them warning of the danger.
Two weeks ago, the Kiowa County Health Department issued a hazardous warning saying dust in Greensburg could contain asbestos. It warned people to wear protective clothing, boots, long pants and gloves, and it began issuing dust masks.
The Kansas Department of Health and Environment warned that residents should be careful when removing debris, and it encouraged homeowners who think there is asbestos in their residences to consider using a private contractor to clean it up.
Kiowa County's health director, Mitzi Hesser, said EPA's air testing should be sufficient in determining the degree of risk in the city.
"There might be asbestos, but at this time, that is all we can do,'' Hesser said. "I feel very comfortable that EPA and KDHE have been doing all that they can do. It is not a normal situation.''
Copyright 2007 Associated Press.
The Search for Truth About the 9/11 Plume, Editorial, New York Post, May 29, 2007
ay 29, 2007 -- Chief Medical Examiner Charles Hirsch this month officially tied the 2002 death of a bystander, Felicia Dunn-Jones, to Ground Zero dust - and thereby heightened fears over the health fallout from the 9/11 attack.
Yes, the ruling provided relief to folks like Dunn-Jones' husband. He had lobbied hard for the designation, and saw it as justice being served.
Others, like Mayor Bloomberg, understandably are concerned that such linkage might unfairly tilt lawsuits filed against City Hall by rescue workers who seek compensation for injuries both real and, sometimes, exaggerated. Ultimately, such cases could cost the city a fortune.
Mayor Mike last week rightly noted one important distinction - between ill workers and folks injured on 9/11 as a direct result of the attacks.
Meanwhile, because Dunn-Jones was exposed to the plume only briefly as she fled the area, the M.E.'s ruling is sparking fears that countless others who breathed the air that day also may have been harmed - and may not even know it.
The question of 9/11's impact on public health is far too important to be decided on the basis of fears, well-meaning sympathy for those who become ill or the financial ramifications of compensating victims.
For New York City and the nation, it is crucial to establish the precise extent of the damage inflicted by the terrorists on that awful day. And to do so solely on the basis of solid evidence - and conclusions that emerge from rigorous, dispassionate scientific inquiry.
This, after all, is a matter of great historical and political import; accuracy and precision count. And neither overstating nor understating the consequences serves the city or the nation.
Alas, emotion and monetary considera tions seem to play an increasingly large role in the shaping of this story.
Politicians (no surprise), their minds made up long before any serious investigation ever began, have fueled the trend.
"The city medical examiner has now accepted what thousands of people with 9/11-related illnesses and their doctors have long understood: that Ground Zero dust was harmful and even deadly," Rep. Carolyn Maloney said last week of Hirsch's decision.
Added New York's junior senator and presidential hopeful Hillary Clinton: "This ruling is an important step toward acknowledging . . . the devastating and growing health impact of 9/11."
Who needs an examination of evidence or serious medical probing, in other words? Everyone's long "known" that 9/11 dust sickened countless people. The only thing research can do, they believe, is confirm conclusions that folks like Maloney, Clinton and Rep. Vito Fossella have espoused all along.
Indeed, Maloney and Fossella lobbiedHirsch to link Dunn-Jones' death to 9/11 dust long ago. They challenged him when he ruled in 2004 that there was insufficient proof of any connection.
Last Friday, they - along with Rep. Jerrold Nadler - urged him to review several other cases of people who died after working at Ground Zero.
This may play well politically, of course. But it does truth a big disservice.
Recall the case of Police Officer Cesar Borja. News reports brazenly attributed his death from lung disease to his service as a first-responder at Ground Zero.
This story buoyed those who blamed 9/11 dust for a widespread health crisis. Clinton invited Borja's son to attend the president's State of the Union Address. President Bush had him to the White House.
But later, The New York Times disclosed that, in fact, Borja never worked downtown until Dec. 24, 2001 - well after the plume had cleared. And that he only worked near the World Trade Center, not directly at the pile of rubble.
Now the question is: What made Hirsch suddenly change his opinion in the Dunn-Jones case?
Hirsch says mounting research convinced him. In a letter this month, he wrote that "accumulating evidence indicates that in some persons exposure to World Trade Center dust can cause or contribute to sarcoidosis with cardiac involvement."
That disease, a lung tissue-scarring illness, had earlier been cited as the cause of death in the Dunn-Jones case.
Hirsch said that, based on new research, he "concluded that Mrs. Dunn-Jones' exposure to World Trade Center dust on 9/11/01 contributed to her death and it has been ruled a homicide."
Yet, as it turns out, Dunn-Jones had sarcoidosis before 9/11. Hirsch cited the air as a possible contributing factor because experts believe exposure to dust can cause the disease to flare up - and that could have been what precipitated her death.
But how can anyone be sure it was exposure to 9/11 dust, and not some other factor, that aggravated the disease?
And even if it were the air, isn't it likely that some other irritant eventually might have set it off anyway, even if she'd managed to avoid the 9/11 plume?
The fact is, the underlying cause of death was her pre-existing sarcoidosis.
Did Hirsch succumb to pressure?
Maybe - or maybe not.
But in an emotion-driven, politically fueled climate, New Yorkers can't be sure.
And that does no one any good.
Let's be clear: Felicia Dunn-Jones' death was a tragedy, and our hearts go out to her family.
Rescue workers, too, can only be viewed as true heroes - if for no more than their willingness to risk the consequences and search for survivors.
And should sound research find post-9/11 air to be the primary cause of any illness, New York, and the nation, have a duty to respond to anyone affected.
In that case, the M.E. must establish causal links to determine each case. And he must resist the efforts of politicians and others - some perhaps searching for grounds for a lawsuit - to influence his decisions.
But Dunn-Jones' death simply was not persuasively linked to 9/11 - at least as the medical examiner explained it.
Politics and science rarely mix well.
This finding sets an unhappy prece dent; it may serve the interests of the tort bar and like-minded advantage-seekers.
But it does not serve justice.
At 39, Sept. 11 EMT Forced to Get New Hip, by Heather Pharo, Press of Atlantic City,May 29, 2007
http://www.pressofatlanticcity.com/news/local/ocean/story/7481940p-7376911c.html
BARNEGAT TOWNSHIP — It all started with the toxic dust that filled Charles Giles' lungs as he worked as an emergency medical technician at ground zero Sept. 11, 2001 — 220 pulverized stories of concrete, steel, plastic, glass, jet fuel and human remains.
That dust set off a chain reaction of health problems. Giles, a Barnegat resident, has 11 prescriptions to fill at the pharmacy. He has been hospitalized between eight and 10 times since the day of the terrorist attacks. And in March, he received a hip replacement at the age of 39, his bones heavily deteriorated by a steroid used to treat his chronic asthma and "World Trade Center cough."
Despite the horror of that day, Giles hasn't shied away from EMT work. Hoping to continue saving lives, he sought out a new kind of hip replacement intended for younger, more active recipients. Developed in England, the Birmingham Hip was approved by the Food and Drug Administration about a year ago, and Giles was the first person to have the procedure done in Atlantic County.
The incision may be bigger, but the hardware is smaller than a traditional total hip replacement. In the latter procedure, the head of the femur is sawed off and replaced with a metal ball and stem that extends well into the bone. The Birmingham Hip is often referred to as a hip resurfacing, because the femoral head is preserved. The stem is just a couple of inches long.
It's a more difficult procedure, requiring keenly precise placement, and takes longer to do — 75 to 80 minutes as opposed to 45 for the total hip — although recovery is quicker. Few surgeons offer it.
Dr. David Rodericks, who performed the surgery on Giles at AtlantiCare Regional Medical Center in Galloway Township, said he knows of only a handful of doctors in New Jersey who offer the Birmingham Hip. In the southern half of the state, he is the only surgeon actively performing the procedure, doing his first hip resurfacing in early March at Southern Ocean County Hospital in Manahawkin.
Rodericks learned the procedure in England from the man who developed it.
Traditional hip replacements carry a higher risk of dislocation and usually put a stop to the recipient's high-impact activities, like jogging and skiing. But the Birmingham hip will enable Giles to lift heavy patients as an EMT with Quality Medical Transport in Barnegat.
"This is a piece of medical equipment that will keep me in the medical field," he said.
On Sept. 11, 2001, Giles was a supervisor with Citywide Emergency Services and lived on Staten Island. Like many rescue workers, he didn't bring a mask to the World Trade Center. Like many rescue workers, he didn't expect the buildings to crumble to the ground.
He outran the collapse of the south tower at 9:50 a.m. When the north tower fell about 40 minutes later, he was yanked out of danger by a Port Authority policeman — his "guardian angel."
Giles was rushed to Jacobi Medical Center in the Bronx, his face and back seared with first- and second-degrees burns. Staff there "decontaminated" him, washing out his eyes and clearing "black junk" from his nose.
He went back to ground zero the next day.
"I did what I had to do," he said.
In January 2002, Giles found himself needing to escape the city, so he moved to Barnegat. Then he noticed his asthma, mild since his teenage years, becoming progressively worse.
Doctors put him on prednisone, an oral steroid, to curb his cough. It was the classic "World Trade Center cough," seen now in thousands of firefighters and emergency responders, Giles said.
Five years of prednisone caused avascular necrosis in his hips, his bone tissue dying off due to decreased blood supply. He'll have to have his other hip replaced eventually.
Even with medication, "my lungs are shot," Giles said. A recent pulmonary-function test revealed his right lung is only 67 percent functional, the result of taking in air that then-Environmental Protection Agency administrator Christie Whitman declared safe to breathe.
"I'm disappointed that the government hasn't done more for all the rescue workers who are suffering ill effects from 9-11," Giles said."We gave our heart and soul that day."
Giles wants to continue to give. He serves on the executive board of the Pinewood Estates Volunteer Fire Company and is shelter manager for Barnegat, helping evacuees from the recent wildfire. He can't work as a firefighter because his lungs are so bad, he said.
Still, he has hope. He went to his first physical therapy session with a walker, "just in case," but by his second session was already walking without aid, said Mitchell Maione, his physical therapist.
Giles can't say enough good things about Maione's work, or about Rodericks' skill, or even about the Birmingham Hip itself. It's those men, along with his fellow volunteers and his wife and two daughters, that keep him going.
"I need to try and keep myself alive for my family," he said.
To e-mail Heather Pharo at The Press: HPharo@pressofac.com
Ailment Bothers Greensburg Workers, by Beccy Tanner, The Wichita Eagle, May 29, 2007
http://www.kansascity.com/105/story/126460.html
They call it the "Greensburg cough."
Some workers, volunteers and residents who have been cleaning up debris from the May 4 tornado have experienced a cough and a sore throat.
Kiowa County and Kansas health officials attribute it to contaminated dust left behind by the twister.
Because the symptoms are relatively minor, there is no way to tell how many people have reported having the cough until it develops into more serious complications.
Rick Sutton of McPherson, Kan., came down with pneumonia after helping clean debris from Greensburg. Because he has had grain dust allergies in the past, the dust from the storms may have made him more susceptible, Sutton said.
"The house we were working on was damp and moldy. You could tell by the smell," Sutton said.
It wasn’t until nearly two weeks after the storm that state and local health officials began cautioning people to wear dust masks or respirators. Now it is common for anyone going to Greensburg to be issued a dust mask.
"We definitely are aware there is a lot of dust in the air," said Carmen Stauth, public information officer for Kiowa County. "Some buildings have been designated as having high amounts of asbestos. Others have mold."
Mitzi Hesser, Kiowa County health director, said the cough is a concern but the numbers of people with symptoms have been small.
"We feel like it is being handled," said Hesser, a registered nurse. "It’s improving as each day goes by."
By comparison, medical professionals in Greensburg are scrambling to treat cuts, scrapes and infections from injuries sustained by workers and residents cleaning up the area. Cuts and scratches that do not heal normally could result in infection.
The initial precaution for the dust masks came after debris and dust were being moved on a daily basis, Hesser said.
Since the storms, the Environmental Protection Agency has been monitoring air quality at the site.
The EPA has established eight locations for monitoring air in and around Greensburg and at its landfill, said Beckie Himes, an EPA spokeswoman.
All samples came back low for concern, she said.
"If it wasn’t low, we’d be doing something," Himes said.
The EPA has helped remove or monitor releases from fuel tanks, chlorine cylinders, anhydrous ammonia tanks, propane tanks and other hazardous materials.
Last week Kiowa County health officials were concerned about the possibilities of asbestos and molds in the air.
And with 1,500 to 1,600 truckloads of debris headed to the area’s landfill, the possibilities for that dust spreading increase.
The Centers for Disease Control Web site cautions that in any situation intense exposures to any type of dust and smoke can cause eye, nose, throat and lung irritation, triggering coughing and sneezing.
The symptoms generally are not a problem if a person is exposed only briefly to the irritants; but if exposure is more long-term or at high levels, more danger to health exists, the CDC says.
Individuals became ill, for example, after the twin towers collapsed in 2001 in New York City and after Hurricane Katrina.
People in Kansas may have an advantage because of the strong winds that will frequently blow pollution away, said Larry Wilkinson, director of the Via Christi Occupational Environmental Medicine program in Wichita.
Still, he cautions that people with asthma or other respiratory conditions should stay away from the area.
"This is like any other major disaster. Small particles can pulverize and be in the air and affect workers," said Kay Johnson, Wichita director of Environmental Services. Her office sent crews to Greensburg to help with disposing of hazardous wastes.
The EPA continues to monitor the air. Signs are posted throughout Greensburg encouraging people to turn their radios to an emergency radio signal that broadcasts alerts.
"We are making sure people take breaks, drink water, use sunscreen and have repellent for the mosquitoes," Stauth said.
It is still too soon to tell what the long-term effects will be on people who have developed the cough, she said.
She believes the "Greensburg cough" could also be attributed to stress.
"There has been a lot of emotional and physical stress put on people," Stauth said.
© 2007 Kansas City Star
Greensburg Cleanup | Do Health Dangers Lurk in Debris? Air Tests Are Negative, but Older Homes Could Harbor Materials with the Toxic Substance, by Karen Dillon, Kansas City Star, May 29, 2007
http://www.kansascity.com/105/story/126459.html
In the weeks since the monster tornado knocked down Greensburg, Kan., hundreds of residents and volunteers have been wading through the debris of nearly 1,000 flattened homes.
Now some experts say the government should be doing much more to protect the health of those residents and volunteers. Many of the homes were built before 1980, when construction materials often contained asbestos.
"It’s a shame, because people are out there and most likely getting contaminated," said Leland Sumptur, a Lenexa asbestos abatement manager who teaches and has consulted nationally.
Government regulators acknowledge asbestos could be contaminating the housing debris — in fact, they have warned homeowners about the possibility of asbestos — but they say they have no evidence of that.
In addition, federal and state regulations do not give regulators authority to require asbestos removal from single-family homes, said Becky Ingrum Dolph, an attorney for the Environmental Protection Agency Region 7.
Beckie Himes, an EPA spokeswoman, said, "We don’t have jurisdiction over these private homes."
She and other government officials say they have done everything they can legally to protect residents and volunteers.
The regulators agree with asbestos experts contacted by The Kansas City Star on several points:
• Asbestos, a known carcinogen, is dangerous when inhaled or ingested.
• At this point, no one knows for certain whether asbestos is present in the rubble of private homes.
• If it were known to be present, the cleanup would be far more controlled to protect the public. In fact, in four commercial and school buildings where asbestos is known to be present, the government has required a strict cleanup and cordoned off the area.
The crux of the debate is over testing.
On May 18 and 19, two weeks after the tornado struck, the EPA took eight air samples in and around Greensburg to try to determine whether asbestos fibers were in the air. The results were negative.
If the samples had been positive, Dolph said, that would have shown there was imminent danger to human health, and a federal provision in the law would have allowed the EPA to move in.
But without positive samples, federal law does not give EPA jurisdiction to take further action. "Legally, we don’t have any authority to require the individual homeowner to do anything," Dolph said.
But several experts said testing by air is not sufficient. The debris should be tested, they said.
"For someone to suggest they did air sampling and they didn’t find anything, that is so wrong to do that," said Celeste Monforton, a researcher and lecturer on public health policy with George Washington University. "It gives some people a false sense of security."
Monforton, who has worked as chief of the Mine Safety and Health Administration’s health division, was involved in cases involving asbestos and miners.
"Really the risk is going to be to the people rummaging through the debris and what they are breathing there," Monforton said. "For someone walking down the street it might not be such a problem."
Sumptur said the probability of asbestos in the rubble should be sufficient for the EPA to declare an imminent danger.
Sumptur said he is using aerial photos of the Greensburg disaster to help teach his students how to identify materials likely to contain asbestos. He said older houses, such as many of those found in Greensburg, often contain asbestos in siding, floor tiles, insulation and plaster.
"I don’t like to assume anything … but it’s more likely yes than not" that there is asbestos, he said. "I would almost stake my job on it."
EPA officials, however, said suspicion is not enough to do materials testing. The "imminent danger" provision of the law requires something stronger, such as positive air tests.
Lonnie McCollum, who resigned as mayor last Tuesday, said in a radio interview the next day that almost half the debris had been cleared.
Residents, volunteers and workers have moved 20,000 dump-truck loads of debris to two giant pits near the town’s landfill. The state says 961 homes were destroyed, 105 had major damage and 67 had minor damage.
One of the first steps that should be taken in securing suspected asbestos in such sites is to wet it down regularly, said Bill Wood, branch manager of Alliance Environmental Group in California, which has dealt with numerous natural disasters such as wildfires and earthquakes.
That keeps the fibers from becoming airborne, he and Sumptur said.
"In this situation where it is raw, and it’s dry, and they are scooping it up, you are talking about anybody who is around, kids or anybody else, could be contaminated," Sumptur said.
When asbestos is removed properly, workers wear protective suits and respirators with cartridges, they said. Large amounts of plastic are used to wrap the debris and contain the fibers.
Some precautions have been taken in Greensburg.
Commercial buildings are being handled differently from homes because they are regulated, government officials said. That means that within days after the tornado, licensed asbestos workers had tested the buildings and determined four, including the high school, contained asbestos.
Those building have been cordoned off, and posters taped to them warn of asbestos. The buildings are being sprayed with water.
As for private homes, the Kiowa County Health Department issued a hazardous warning two weeks after the tornado saying dust could contain asbestos. It warned people to wear protective clothing, boots, long pants and gloves, and it began issuing dust masks.
On Thursday, the Kansas Department of Health and Environment issued a hazard declaration warning that residents should be careful in removing tornado debris, and also encouraged homeowners with suspected asbestos materials to consider using a specially trained private contractor.
Sumptur said that if there is cancer-causing asbestos, dust masks probably will not protect people from the fibers — special respirators are needed.
Mitzi Hesser, the county’s health director, said EPA had tested the air.
"There might be asbestos, but at this time, that is all we can do," Hesser said. "I feel very comfortable that EPA and KDHE have been doing all that they can do. It is not a normal situation.
"We are doing all we can to keep everybody as safe as possible."
To reach Karen Dillon, call 816-234-4430 or send e-mail to kdillon@kcstar.com.Back to Top
Once more, Sen. Hillary Clinton and Reps. Carolyn Maloney, Vito Fossella and Jerry Nadler have had to prod, push and pummel Washington into meeting the nation's obligation to men and women who responded to an act of war and were afflicted as a result with serious lung conditions, some fatal.
This time, the four officials got money - $50 million - by attaching the appropriation to the Iraq war funding bill. President Bush will sign the measure to continue prosecuting the conflict. That's his concern, and an appropriate one.
But Bush is not similarly concerned about the medical, psychological and financial difficulties of the 9/11 responders - or so the evidence indicates. In the vast reaches of his administration, no one is standing up for these forgotten victims of 9/11. Most shamefully, Health and Human Services Secretary Michael Leavitt has postured as an ally for the sick and conducted himself as their enemy.
The only hope, it seems at the moment, resides in Congress, where Clinton in the Senate and the stalwarts in the House must continue the prodding, the pushing, the pummeling. And to their ranks now must be added Rep. Frank Pallone, who heads a pivotal House subcommittee.
Aside from simple decency, Pallone has more than 1,000 reasons to step to the fore in the battle. His district is just across the Hudson and abuts Staten Island. More than 1,000 of his constituents have joined the city Health Department's World Trade Center registry because they are concerned that breathing Ground Zero toxins damaged them, perhaps irreparably.
Pallone's district is also home to a contingent of first responders large enough to require the attention of a 9/11 center of excellence at the University of Medicine and Dentistry of New Jersey in Piscataway, home turf to the congressman.
Patients suffer with asthma, bronchitis, sinusitis, shortness of breath, chronic coughing and lung-scarring diseases, such as pulmonary fibrosis. All need specialized treatment; many lack health insurance.
The scope and gravity of the epidemic of are only now beginning to gain widespread recognition. Last week, for example, the city medical examiner concluded for the first time that exposure to the dust produced by the disintegration of the towers had caused a fatality. The roster of the slain grew from 2,749 to 2,750.
After long resisting, Dr. Charles Hirsch reexamined the case of Felicia Dunn-Jones, a Staten Island wife, mother and lawyer who was working a block from the Trade Center on the day of the terror attack. Caught in the cascading remains of the buildings, Dunn-Jones contracted sarcoidosis, a condition that scars the lungs and can attack the heart. What seemed a simple, persistent cough proved suddenly fatal five months later.
Hirsch's ruling removes all doubt that the air downtown was lethal - even as the Bush administration purports to have doubts that inhaling pulverized concrete, glass, asbestos, mercury, lead, dioxins, the fumes of burning jet fuel and dozens of other poisons caused widespread, lasting harm.
Leavitt knows better. Last year, he appointed Dr. John Howard, chief of the National Institute for Occupational Safety and Health, as 9/11 health coordinator. But when Howard recognized the enormity of the catastrophe, with its financial implications, Leavitt superseded him with a trusted deputy, Dr. John Agwunobi.
At the time, Leavitt promised to deliver a comprehensive nationwide treatment plan. Said plan was due in February. It never saw the light of day. Instead, Agwunobi has insisted that he needs more and more data to figure out what's happening and how to respond. This is paralysis by analysis - a deliberate tactic to delay and dodge because, you know, sophisticated health care costs money.
But the sick of 9/11 cannot wait. Nor should the leading treatment efforts, run by the city Fire Department and Mount Sinai Medical Center's World Trade Center Consortium, have to function hand-to-mouth. Particularly when the patient census at Mount Sinai and affiliated hospitals stands at some 6,000 and grows monthly.
All of which is why Congress must rise to the occasion, and why Pallone must become an aggressive advocate for the sick. As chairman of the health subcommittee of the House Energy and Commerce Committee, he is positioned to shoulder the leadership that Leavitt refuses to accept.
The subcommittee must hold hearings, bring in experts from around the country, educate Congress about the best practices for treating the injuries and illnesses suffered by 9/11 responders and devise a long-term plan with long-term funding.
Pallone must become a force in the House, as Clinton is in the Senate, and force Washington to do the right thing for people who responded with valor in America's time of need.
All contents © 2007 Daily News, L.P.
9/11 Respirators, Letters to the Editor, by Peter Allar, New York Times, May 29, 2007
To the Editor:
Re “Macho Mistakes at Ground Zero” (editorial, May 22):
As a nurse in the emergency room at St. Vincent’s Hospital on 9/11, I can verify that all of the victims and all of the emergency responders who came to us for help that day were covered from head to toe in a layer of white dust.
Someone on staff with sense and foresight (it wasn’t I) retrieved the hospital’s supply of N-95 respirator masks, which we use primarily when treating patients with TB, and our staff threw cartons of these masks into the backs of ambulances and police cars headed back downtown to the World Trade Center.
Days and weeks later, we were treating dozens of responders around the clock for acute respiratory problems. On that terrible Tuesday, the shock and horror of what had unfolded and the loss of so many friends and colleagues overshadowed the need for self-preservation. There is something very humane about that, and very tragic.
Peter Allar
New York, May 22, 2007
Copyright 2007 The New York Times Company
Civilians a new Wrinkle in Ground Zero Claims, by Maggie Haberman, New York Post, May 28, 2007
ay 28, 2007 -- Seven city workers who weren't first responders on 9/11 have been out with injuries and receiving workers'-compensation benefits since the day of the attacks, officials told The Post.
According to the city Law Department, the seven people have made claims for a range of injuries, and are civilian workers with the NYPD, FDNY and Office of Management and Budget.
Officials wouldn't provide details about their injuries or their titles.
Overall, officials said, there are 35 cases of workers who aren't cops or firefighters who are currently getting workers' compensation for 9/11 claims.
Another four such people have died, and their families are getting their death benefits.
The number emerged last week, just as the city medical examiner reclassified the death of a federal Department of Education worker as related to Ground Zero dust. Felicia Dunn-Jones was caught in the toxic plume as the Twin Towers collapsed.
Several lawyers representing people, many of them rescue workers, who say they suffered bad health effects from breathing the soupy mix of poisons have indicated they will use the ruling in the Dunn-Jones case to bolster their own cases.
A Law Department spokeswoman said that since the law was changed last August, it had received only about another 90 claims.
Of those, she said, almost none have been approved.
But Robert Grey, who represented former Deputy Mayor Rudy Washington in his own claim, insisted the city is dramatically underestimating how many claims it has received - and said so few have been approved because the city is fighting the rest.
"If the city is proud of how it's treated 'emergency' personnel who responded to 9/11, it should remember that the so-called non-emergency personnel [civilian workers] showed up at the same time, did a lot of the same work, and had the exact same toxic exposures," he said.
"Why is it that when it comes to having their medical bills paid and their lost wages reimbursed, they become second-class citizens?"
maggie.haberman@nypost.com
Copyright 2007 NYP Holdings, Inc. All rights reserved.
NY pressed to review deaths of Ground Zero workers, by Edith Honan, Reuters, New York, May 26, 2007
http://www.abcnews.go.com/Health/wireStory?id=3218840
Activists, including U.S. presidential candidate Hillary Clinton, put fresh pressure on New York City on Friday to compensate Ground Zero workers following the first confirmed death from inhaling the dust of the World Trade Center wreckage.
Clinton called on the city's chief medical examiner to examine the cases of workers and downtown Manhattan residents whose deaths and illnesses could have been caused by exposure to toxins at the site of the Twin Towers collapse and at the landfill where the wreckage was taken.
This week Chief Medical Examiner Charles Hirsch ruled the death of Felicia Dunn-Jones -- a lawyer who ran through the thick clouds of dust as she fled the collapsing towers on September 11, 2001 -- was linked to her exposure to the dust. He included her death five months later in the official tally of September 11 victims in New York, which is now 2,750.
Victims' rights groups said Dunn-Jones is the only victim to have received a death benefit from the Victim Compensation Fund for an illness caused by wreckage of the Twin Towers, which fell after they were struck by two hijacked airlines.
"Your recent decision to include Felicia Dunn-Jones in the official list of 9/11 victims is an important step toward acknowledging and coming to terms with the devastating and growing health impact," Clinton said in a letter to Hirsch.
U.S. Reps. Vito Fossella, a Republican, and Carolyn Maloney, a Democrat, also urged Hirsch to review other cases of people who had fallen ill since the September 11 attacks.
"If the toxins at Ground Zero could be responsible for the death of Felicia Dunn-Jones, who was trapped in the dust cloud for one day, think about the impact the toxins must have had on rescue and recovery workers who toiled at the site for months," Maloney said in a statement.
Marianna Pizzitola, the president of an association for retired emergency services workers, said workers who are suffering from leukemia, post-traumatic stress disorder and other illnesses are looking for "an acknowledgment from the city that their illnesses are real."
She said emergency workers who have had to miss work due to their illnesses are sometimes not compensated because the city has been reluctant to accept claims that their illnesses were caused by their exposure to the toxic dust, rather than a pre-existing condition or something unrelated to the dust.
New York Democrats in Congress said that $50 million had been set aside for September 11 health needs in a congressional appropriations bill, which awaits the approval of President George W. Bush.
Copyright 2007 Reuters News Service. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed
9/11 claims another victim as dust is linked to lawyer's death, by David Usborne in New York, The Independent, U.K., May 26, 2007
http://news.independent.co.uk/world/americas/article2584129.ece
Almost six years after terrorists tore a hole in Lower Manhattan, the medical examiner's office has stirred controversy by determining that a woman who died months later from a rare lung disease after inhaling toxic dust from the collapsing Twin Towers will be added to the official list of victims.
Felicia Dunn-Jones, a civil rights lawyer, worked in a building a block from the World Trade Centre and inhaled pulverised particles of cement, glass, lead and asbestos as she fled the area of destruction on September 11 2001. Within a few weeks she developed a cough and died in February 2002.
A spokeswoman for the office, Ellen Borakove, said the case of Ms Dunn-Jones was the only 9/11-related fatality it had formally been asked to review, and the only one definitely linked to the collapse of the towers, but indicated others might be considered. "We certainly never turn anybody down," she said.
The decision of the chief medical examiner, Charles Hirsch, means that the death toll at Ground Zero after the inclusion of Ms Dunn-Jones rises to 2,750. Another 184 people were killed the same morning at the Pentagon outside Washington, as well as 40 who died in a hijacked plane that crashed in Pennsylvania.
It has stirred fresh anxiety, however, not least among families of those who died in the rubble itself on 9/11, who wonder how many others might be added to the roll of victims in the future.
Within hours of the announcement, union leaders who represented emergency rescue workers who died after being deployed to Ground Zero were asking if they should not similarly be added to the list. "First responders who expired as a result of their 9/11-related injuries should in fact be given that same honour," said Michael Palladino, president of the Detectives Endowment Association.
Additionally, questions were instantly raised about the growing numbers of city workers who joined the months-long clean-up effort at Ground Zero and who are now suffering from breathing problems. Thousands have recently joined a class-action lawsuit seeking to sue the city for negligence.
Police officials pointed to the case, for instance, of 34-year-old James Zadroga, a detective who became ill and died of respiratory disease after working for hundreds of hours at the Ground Zero site. A medical examiner in New Jersey ruled that his death in 2006 was "directly related" to his clean-up duties.
Indeed Mr Zadroga's father, on hearing of Ms Dunn-Jones' change of status, said he would submit a request that the city review the case of his son. 'I'm going to go through the process, definitely," Mr Zadroga said. "All these guys were heroes there. They're all dying." Mayor Michael Bloomberg said all decisions regarding the death toll numbers rested with the medical examiner. "It's his definition that we will follow in this city." But he made a distinction between what happened to Ms Dunn-Jones and to clean-up workers now suffering medical problems.
"This one case... the woman was killed as a result of being there at the time of the attack," he said. "Think of it as though somebody had a beam fall on them and it just took a little while for them to succumb to their injury. Not somebody who was injured the next day if a beam fell on them during the clean-up. That's a very different situation."
But some legal experts thought the decision would add energy to the class lawsuit against the city, which 10,000 plaintiffs have joined. "I have clients who are saying, 'should we dig up the bodies and have autopsies and have tissue samples'," said David Worby, who will represent them.
Ill ground zero workers: U.S. failed to help, by Erika Hayasaki, Times Staff Writer, Los Angeles Times, May 26, 2007
Two subjects of a new Michael Moore documentary say they went to Cuba for the medical care they couldn't get in the States.
NEW YORK — Two subjects of a new documentary film joined the chorus of voices determined to focus attention on people who have developed debilitating health problems after breathing toxic dust from the collapsed World Trade Center towers.
William Maher and John Graham traveled to Cuba as part of "Sicko," a documentary on the U.S. healthcare system by filmmaker Michael Moore. He brought the men, who had helped clean Lower Manhattan, to Cuba to try to get medical treatment for them at the U.S. naval base at Guantanamo Bay.
In the film, Moore argues that terrorism suspects at the detention facility there receive better medical care than the heroes of 9/11. He heads toward Guantanamo in a boat with ground zero workers, and as cameras roll, Moore calls out through a bullhorn that he wants to bring his friends for treatment at the base. He gets no response, so he takes them to Havana. Healthcare is free in the communist country.
Maher and Graham, who spoke at a news conference Friday held by U.S. Rep. Jose E. Serrano (D-N.Y.), said they went to Cuba after the U.S. government and healthcare system failed to provide the support for medical treatment they needed.
New York City agreed this week to include on the official list of Sept. 11 victims an attorney who died of lung disease months after the attacks. Hers is the first death the city medical examiner has confirmed to be the result of dust from the twin towers' collapse. (It was the only such death the office had been asked to review and definitively link to the collapse, office officials said.)
"For those who are still suffering, hopefully we can get the help to them that they have not been able to get," said Maher. "Some, as we speak, are dying."