Extended Interview: Researcher Discusses Health of 9/11 First Responders
Philip Landrigan, chairman of the Community and Preventive Medicine Department at Mt. Sinai School of Medicine in New York, discusses the department's recent report on the health of 9/11 first responders.
http://www.pbs.org/newshour/bb/science/july-dec06/landrigan_11-21.html
11/21/2006
TOM BEARDEN: Mt. Sinai has just completed a major study of the people who responded to the World Trade Center. What did you find?
PHILIP LANDRIGAN: Well, we reported on about 9,200 workers: firefighters, police, construction workers, other responders at the World Trade Center site. The major finding that we recorded was that approximately 60 percent of these people had developed new respiratory symptoms since starting work at Ground Zero.
TOM BEARDEN: Sixty percent is significant.
PHILIP LANDRIGAN: Sixty percent is very significant and it's much higher than we would expect in the general American population. And our assessment of the severity of the situation was heightened by the finding that in roughly two-thirds of these people the signs and symptoms were so persistent two or three years later.
TOM BEARDEN: What kind of problems did you find?
PHILIP LANDRIGAN: Well, first of all we found upper respiratory problems. Very ... nasty, very acute sinusitis in a lot of these folks. And then also lower respiratory problems -- cough, wheeze.
And then objectively going beyond just symptoms, we actually did what are called pulmonary function tests where people are asked to blow hard and fast into a tube and measure how much air they move in a given period of time. And we found lots of evidence in that test for pulmonary restriction, which is to say shrinkage in the volume of the lungs. And in one particular test the frequency for evidence of restriction was five times what we would expect in the general population of the U.S.
TOM BEARDEN: We spoke with two police detectives -- one who has cancer, has leukemia, and the other who has lost 50 percent of his kidney function. Is it possible to attribute those sorts of problems to Ground Zero?
PHILIP LANDRIGAN: Up until now we've been focusing on two things -- respiratory problems and mental health problems. Because it was clear to all of us that those were the two categories of disease that were going to be most important in the first five years after the attacks.
Now that we've gotten past the five-year point and we're moving into the period of time when you would begin to expect to see diseases that have a long [incubation] period, we're actually engaged in a process right now to develop criteria for which other diseases such as cancer, such as chronic lung disease, such as kidney disease, such as other diseases like he included on that list.
TOM BEARDEN: But it's too early to know for sure?
PHILIP LANDRIGAN: We're working to get it right because all recognize that it's very important that the list has to be accurate. We have to be sure to provide benefits to anybody who deserves benefits and we don't want to make any mistakes.
Range of illnesses
TOM BEARDEN: Of the 60 percent of the people that you've identified so far, how would you characterize the seriousness of the problems that they've suffered?
PHILIP LANDRIGAN: There's a range of course, and what we found was that the people who had the most serious disease are the people who were there first. The people who actually were engulfed in the dust cloud that we all saw on TV on 9/11 are far and away the most seriously affected.
Then the next most seriously affected are the folks who arrived in the first 24 hours but missed the actual dust cloud. Next most seriously affected are the people who arrived 24 or 48 or 72 hours after the events, and so on down.
And actually the fact that there is that internal gradient -- that internal dose response -- strengthens our feeling that this is a true cause and effect relationship that we're seeing.
We think that the likely cause ... of all the respiratory problems lies in the chemical nature of the dust. The major component of the World Trade Center dust was pulverized concrete. Cement. Which was very, very alkaline. Had a pH of 10 or 11, which means that the alkalinity of this material is equivalent to that of Drano.
And moreover it was in finely particulate form, so that when people inhaled this stuff it actually had the capacity to adhere to the lining of the trachea, the bronchi, and even -- because it was small -- moved on into the depths of these people's lungs.
And we think that's why the material was so incredibly toxic per unit weight. Then of course in addition to the pulverized cement, there were billions and billions of microscopic shards of glass from all the blown out windows and various chemical contaminants.
TOM BEARDEN: An attorney who represents some of those people who are involved in a class action suit believes there was perhaps an accelerating in the mixture of the chemicals and so forth that was in the cloud that might make these more serious diseases appear more quickly. Is that possible?
PHILIP LANDRIGAN: It's possible. We certainly know of other instances of synergy, acceleration between chemicals. The classic example that was recognized 30 years ago ... was the synergy that existed between asbestos and cigarette smoke. We know that asbestos workers who smoke cigarettes had much more lung disease, specifically much more lung cancer, than asbestos workers who didn't smoke. So the notion of plausibility is certainly real and we need to explore it in the case of 9/11 people.
TOM BEARDEN: Is there a timeframe -- that a clock is ticking right now, if you will -- that will require a period of time for studies to link directly to cause and effect, or is that pretty much established now?
PHILIP LANDRIGAN: I would consider it quite well established in the case of the pulmonary disease that we're seeing, and quite well established in the case of the mental health problems that we're seeing. And still a work in progress for some of the other conditions.
TOM BEARDEN: How long would the other conditions take to become apparent scientifically?
PHILIP LANDRIGAN: That is not entirely certain. And the thing is here, we just don't know with any absolute certainty how many years it will take for various other diseases to appear in these folks. Will it be one year, three, five, 10, 20?
We know for example in the case of the cancers caused by asbestos that they can appear as long as four and five decades after the fact. That's probably longer than most, but still gives you a sense of the time frame that we're operating in. So I think our responsibility as doctors who are caring for these people is to continue to examine them conscientiously, to continue to publish our reports every couple of years as new data become available, and continuously to sift the evidence and see what the connections are.
And at the same ... we need to work with the folks who are appropriating new funds to make sure that this is a study with uninterrupted stream of funding, to support these examinations so that we're in a position to see new diseases as they appear.
Funding of health evaluations
TOM BEARDEN: Do you think that there's a danger that the government -- state, local and federal -- might forget about this and that that steady funding stream that you think is so important might dry up?
PHILIP LANDRIGAN: I don't think there's a real risk that government will forget the workers of 9/11. These folks are national heroes. They rushed into the scene at Ground Zero hours after the attack on the towers and some of them continued to labor there for six months. I think that ... at all levels of government, city, state and federal, there is such support for continuing evaluations for these workers. I simply cannot conceive that it would go away.
TOM BEARDEN: Those two first responders I mentioned earlier told us about how they went home with this stuff all over their clothes, and they took it home and their families were exposed to it. Are you concerned about health risks to those people secondarily as well?
PHILIP LANDRIGAN: Well, there have been numerous examples recorded in occupational medicine of people carrying toxins home with them from the workplace to cause illness in their families. It's been seen in lead workers, it's been seen in asbestos workers, it's been seen in workers in pesticide plants. And so yes, we need to be concerned in this instance.
TOM BEARDEN: Can you put a number on the number of people we might be talking about here ultimately?
PHILIP LANDRIGAN: We have reasonable estimates of the number of people who worked at Ground Zero and at the other sites that were directly exposed to the dust, such as the Fresh Kills Landfill, and it's somewhere between probably 40,000 and 60 or 70,000.
We're working right now with the city health department to refine that number. What's more difficult to calculate is the total number of people outside the workplace in ... Manhattan who were exposed to the dust. The city health department has set up a registry and they're working very hard to try to come up with a very accurate estimate of that.
TOM BEARDEN: Is it possible to say what the lower and upper numbers of those might be?
PHILIP LANDRIGAN: I'd rather not commit at this point.
Reaching out to workers
DAVID STEPHEN: As science goes through its process of determining what happened and what to do about it, is there a risk that people may die in the meantime because they're getting sicker faster than anybody anticipated?
PHILIP LANDRIGAN: Well, I think one of the very strong arguments for continuing the medical monitoring and medical follow-up of the responders at the World Trade Center is that we need to be in a position to document any accelerated occurrence of disease. So I think it's a good idea that we should see each of these people every one to two years, that way if any disease of rapid onset is developing, we'll pick it up early.
And picking it up early has two benefits. First off it means that we can put those people on treatment as soon as we pick up their disease, and secondly, early detection means that we'll be in a position as rapidly as possible to recognize emerging patterns of disease so that we can consider interventions that go beyond the treatment of the individual worker.
DAVID STEPHEN: So the solution then is to monitor and to pick up any problems [in] as many people as possible on an ongoing basis?
PHILIP LANDRIGAN: Absolutely. Yes, the solution to the risk of early emergence of disease is continuing follow-up -- periodic exams every one to two years, continuing surveillance of the data so that we're in a position to observe patterns as they develop, and then of course intervention.
DAVID STEPHEN: How do you reach those folks who may not want to know, and they're worried about going to see a doctor?
PHILIP LANDRIGAN: Well you know, in all my years as a doctor, one of the constant struggles is to persuade people who are fearful of the medical profession to come in for examinations ... it becomes very important that we as physicians reach out to those people, that we persuade them that we need to overcome that fear of examination, come in and be checked.
And the reason that it's important that they be checked is not that they be given bad news, but rather that we're then in a position to intervene quickly and effectively to minimize the risk of disease, or minimize the risk of premature death.
We have developed a very active program of outreach to the workers who were down at Ground Zero and we're constantly sending out messages. We're doing some in multiple languages because we realize that the workers came from many different backgrounds and a very substantial [part of] our budget is for this outreach effort. We take it very seriously.
Learning from the past
DAVID STEPHEN: Some people see some historical precedence for what's happening here. They see it in the atomic veterans who were exposed to fallout from the nuclear attacks. They see it in the dioxin issues. They see it in Gulf War syndrome. They see it in Agent Orange and it seems to them at least that science is always about 10 years or 20 years behind in terms of determining who got hurt by what and who's going to pay for all this treatment. Is that something that, that's happening here too?
PHILIP LANDRIGAN: I think we've learned from past crises. For example, I sat on federal advisory boards on dioxin. I was a member of the Presidential Advisory Commission under President Clinton on Gulf War veterans' illnesses. The medical profession has learned from those past experiences how to mobilize in the aftermath of this kind of disaster, how to separate truth from untruth, how to focus resources to the benefit of patients.
And I would argue that the response here has been much more rapid, much more focused and much more compassionate than it was in any of the previous crises. I mean we were starting to see patients -- World Trade Center responders -- within a month or so of September 11th, 2001, and the pace we're seeing patients has only accelerated since that time. We've seen now a total of over 17,000 patients at Mt. Sinai and the fire department has seen another 13 or 14,000. So roughly 30,000 between us. That's an extraordinary response and unmatched by anything that I can recall in any of the previous events that you mentioned.
