A Fallen Hero - Video Inside

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

http://www.villagevoice.com/news/0736,rayman,77703,2.html

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

End Part I

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

End Part II

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

End

TWO 9/11-SICK COPS DIE

http://www.nypost.com/seven/09062007/news/regionalnews/two_9_11_sick_cops_die.htm

By LARRY CELONA

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

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

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

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

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

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

Accuracy of 9/11 Health Reports Is Questioned

http://www.nytimes.com/2007/09/07/nyregion/07sinai.html?pagewanted=1&_r=2&hp

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

End Part I

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

by Michael Mason
9/7/2007

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

End Part I

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

End Part II

“There were two separate pollution events, and the first was an initial dust cloud,” Cahill explains. “What must not be forgotten is that the later effects from the smoldering pile were far, far worse.”

Unlike the publicly lambasted EPA tests and findings, Cahill’s studies, which were published in peer-reviewed forums, were widely praised for their accuracy. Though the University of California at Davis has offered the conclusions to the EPA, the Senate, and New York City health officials, Cahill says he isn’t aware of a single state or federal agency that has acted on his findings. Through sample analysis, Cahill first discovered that 21 percent of the initial dust cloud contained finely powdered, highly caustic cement—thought to be responsible for the “9/11 cough.” Cahill noticed that the heat generated by the piles was converting gases into highly toxic, very fine aerosols. His study “Analysis of Aerosols From World Trade Center Attack” indicated that the contaminated air sometimes descended to ground level over a mile from Ground Zero, far outside the safety zones established by the EPA. Within a few hours’ time, a person exposed to the fumes could ingest toxins that would otherwise take a year to accumulate in a typical environment.

“The fuming World Trade Center debris pile was a chemical factory that exhaled toxins in a particularly dangerous form that could penetrate deep into the lungs of rescue workers and local residents,” Cahill and his fellow researchers concluded.

It’s painful just listening to Susan talk on the phone. Her gasps and wheezes and long pauses in conversation give you the impression that she may not make it through an entire conversation, and I caught her on a good day. A bad day means that she won’t even be able to make the trek from Queens to her office downtown.

“The public isn’t aware of just how bad the effects have been,” Susan says.

“Susan,” an anonymous source, was one of 386,000 people who worked in Lower Manhattan before the attacks. A week after the attacks, she returned to her job downtown.

“Within 24 hours of returning to work, I had a problem,” she warbles. “I could not breathe at the office.”

Even though she had heard the assurances of officials on television, today she bears the signs of serious toxic exposure: internal chemical burns, chronic respiratory infections, and severe asthma attacks.

For average citizens like Susan, New York City offers only one publicly funded treatment option: the WTC Environmental Health Center (WTC-EHC) at Bellevue Hospital, a new program launched in January 2007 that will expand to treat about 6,000 New Yorkers with 9/11-related health problems. The World Trade Center Medical Monitoring and Treatment Program based at Mount Sinai and the Fire Department of New York’s Bureau of Health Services programs offer services to first responders. Politicians have proposed $1.9 billion in funding over the course of six years.

“We get about 100 to 200 calls a week,” says Dr. Joan Reibman, director of Bellevue’s WTC-EHC. “We have a couple of hundred people waiting, so to get an appointment takes six weeks.”

The Bellevue clinic currently serves about 1,300 patients in all. Although the three WTC treatment programs have been praised by Mayor Bloomberg’s office, Reibman explained to me that the WTC treatment programs were initiated by private organizations.

“Neither the city or the federal government asked anyone to start any of the programs,” she says. Eventually the programs drew the support of city officials and gained funding.

Critics of the WTC health programs contend that there is no central entity that integrates the gathered information, which could provide a greater understanding of disease incidence as well as a certain level of continuity of treatment.

“We [the WTC health programs] all work together on the development of guidelines,” Reibman says. “We all share our information with each other. We have different populations, so our questionnaires are different.”

Although it still makes her ill, Susan continues to plod downtown to work. She says sometimes the air in her workspace makes her eyes burn, but she doesn’t have a choice—disability payments won’t cover the rent or put food on the table.

“You can’t dwell on it every single minute,” she says. “If people dwelled on what happened, nobody would live downtown because they would be too frightened.”

Curious about whether the workers and residents of Lower Manhattan are still haunted by health problems like Susan’s, Nina’s, and Teroy’s, I took a walk through the streets surrounding the 9/11 reconstruction site. Although six years have passed since the attacks, the number of people I encountered seemingly with residual health problems surprised me.

“They told us it would be OK to come back here,” recalls Nicholas Rowe, a silver-haired bartender at a nearby Blarney Stone restaurant and bar. In an Irish lilt, Rowe chose colorful words to denounce the EPA’s assurances, none of them printable.

“Three months after the attacks, we would open the bar doors each day,” Rowe recalls. “And every time I would wipe off the bar counter, there was black dust. Now I have nose and throat and sinus infections that keep coming back, and I never had those before. My regulars come in with problems too.”

Just a couple of blocks from the Blarney Stone, I stopped and chatted with Jim Moock, a director of business development at CQG, a market-data provider located in a Broadway high-rise.

“Some people had painter’s masks on their faces, apparently the cops were giving them out,” Moock said, recalling the day of the attacks. “I didn’t get one. It was chaotic, and the only clear thought I had was, ‘Why didn’t I get one [of the masks]?’”

Moock developed a dry, hacking cough about two weeks after the attacks. Finally, after two months of aggravation, Moock scheduled a visit with a pulmonologist. That visit has resulted in the first of many subsequent checkups throughout the years.

“He gives me a test every year or two, and it has shown diminished [lung] capacity,” explained Moock. “He has me on two forms of inhaled medications that I take daily every morning. One is steroid based, and I’ve been on them since 2001.”

Moock believes he was exposed to the toxic dust in a number of different ways. “When it got to be windy, you would see it blow off the window ledges, and I would be outside and see it land on the sidewalk, and it would just sit there like a clump, not like ashes that would just blow away,” Moock said. “This went on for months. I remember watching it rain on this stuff, and it took a lot of rain to get rid of the dust because it was so dense.”

Moock claims he hasn’t seen the familiar pockets of dust for a long time, but does it mean the city is now clean and safe?

In March 2004, in an attempt to “get greater input” regarding the health concerns of New Yorkers, the EPA convened the World Trade Center Expert Technical Review Panel, made up of 18 professionals from academia and public-health organizations. The panel’s goal was to assess any remaining exposures and risks, ascertain any public-health needs that were unmet, and then to offer a recommended course of action. In order to arrive at educated suggestions, the panel needed solid data.

“The whole process [of gathering data] has been extraordinarily poor in terms of understanding the extent to which people were exposed and possibly remain exposed, and if there are pockets of pollution left,” says Jeanne Stellman, a professor of public health at Columbia University, who served on the panel.

Various panel members criticized the EPA’s testing methods, suggesting that the data obtained weren’t sound enough to draw the conclusions the EPA had acted on. “There is only a limited amount of data available on what the nature of the exposure was, which varied day to day and hour to hour,” Stellman explains. “There was remarkably little sampling and analysis.”

End Part III

With so little data available, the panel wasn’t able to determine if the city still required cleanup or not. Too many questions remained unanswered. “At any rate, the issue of cleanup was never resolved,” Stellman says. “And we never got up to the public-health aspects that we were charged with doing.”

The EPA disbanded the WTC Expert Technical Review Panel in December 2005 without explanation. Few recommendations made it into the public record as a result. Instead of continuing the panel, the EPA decided to implement a second program launched in December 2006. The plan intended to address the cleaning and abatement needs of residents of Lower Manhattan, in the exact same locations it had addressed in its first criticized attempt.

In its June 2007 congressional testimony, the Government Accountability Office (GAO) reviewed the WTC panel’s recommendations and corroborated its assessments. The GAO review stated that the EPA’s decision to incorporate only some, rather than all, of the panel’s recommendations undermined the validity of the second program.

“The majority of panel members do not support EPA’s second program,” the GAO report concluded. “[The second program] was not responsive to the concerns of residents and workers . . . it was scientifically and technically flawed.”

Robert Gulack, an attorney with the federal government, thought he had escaped the toxic environment caused by 9/11. When his department relocated into the Woolworth Building following the destruction of 7 World Trade Center, it took him only a few days to notice the effect on his breathing.

“Three days later I woke up with a severe asthma attack,” Gulack says. “More than half of my coworkers raised their hands during a meeting and said they had illness since coming into the building.”

To the alarm of his coworkers, Gulack began wearing a double-canister respirator to work every day. The precautions couldn’t deter the onset of problems from the contamination he had already suffered, though.

“I was certified as a scuba diver, and I had great lung capacity,” he says. “Now a scan shows damage to my lungs and hyperreactivity to irritants.” Once Gulack was rushed to the hospital for pneumonia following a number of bronchial infections. Now his illness carries a diagnosis of reactive airway disorder.

Gulack explained that even though his agency had received assurances about the building’s air quality from both the landlord and the EPA, later testing (by a private company) proved the area was dangerously contaminated.

“I know that I was exposed to things that no human being should be exposed to,” Gulack says. “Not only have I been exposed to asbestos but probably a number of other life-threatening contaminants. I’m 53, I have a wife and kids, and I don’t want to be taken away from them. There was no reason to subject me to those dangers—no justification for this at all.”

As a union steward, Gulack has advocated for employee health concerns and has closely monitored the EPA’s actions since 9/11. He believes that instead of learning from all its mistakes, the EPA remains unprepared for another crisis.

“New victims are being claimed every day as a result of this contamination,” Gulack says. “The EPA has officially taken their bad choices and made it their model. Now all crises will be handled politically, through the White House.”

The EPA’s calamitous handling of the 9/11 cleanup brings White House involvement into question. The damning OIG report showed that important public-health information was held back by Bush’s Council on Environmental Quality, and evidence also suggests that critical press releases were altered, making them contradict scientific fact. As the report noted, “the White House Council on Environmental Quality . . . influenced, through the collaboration process, the information that EPA communicated to the public through its early press releases when it convinced EPA to add reassuring statements and delete cautionary ones.”

Gulack’s concerns are substantiated by another indictment of the EPA—this time in their handling of the hurricane Katrina disaster in New Orleans. A June 2007 report from the GAO contains an eerily reminiscent passage: “EPA’s assurance that the public health is being protected from the risks associated with the inhalation of asbestos fibers is limited because the agency has not deployed air monitors in and around New Orleans neighborhoods where demolition and renovation activities are concentrated.”

Within sight of Ground Zero quietly stands the Statue of Liberty, seemingly ignored in our post-9/11 world. But like an oracle from a distant time, she offers prophetic words of concern. In the shadow of the attacks, the inscription at her base no longer seems to address immigrants but rather speaks directly to New Yorkers who now find themselves disenfranchised and suffocating with disease: “Give me your tired, your poor/Your huddled masses yearning to breathe free.”

Yet some leaders are speaking up for sickened New Yorkers. Representatives Carolyn Maloney and Vito Fossella of New York introduced the James Zadroga 9/11 Health and Compensation Act, which would expand the current health programs for first responders, area residents, office workers, and students. New York representative Jerrold Nadler tirelessly champions decisive action on behalf of New Yorkers who are still susceptible to toxins.

“We have to clean this up; it was never done properly,” says Nadler, who also says cleanup efforts could run several billion dollars, but there is no exact figure because nobody knows how extensive the contamination is and if it extends to Brooklyn as well.

Because adequate testing has yet to be conducted, nobody knows for certain just how toxic Lower Manhattan remains, but there are plenty of indicators that the 9/11 attacks are still dismantling the downtown infrastructure. Two former Deutsche Bank buildings downtown will soon be demolished as a direct result of 9/11 contamination, and more demolitions are expected.

“To clean it up, it costs between $10,000 and $20,000 per apartment,” Nadler says about the current price of adequate cleaning. “Are you going to ask a resident to pay that?”

On June 25, 2007, former EPA administrator Christie Todd Whitman testified before a congressional hearing and repeatedly denied any wrongdoing or culpability in the EPA’s handling of the disaster. Nadler, who represents nearly all of Lower Manhattan, presided over the hearings.

“Let’s be clear: There are people to blame,” Whitman said. “They are the terrorists who attacked the United States.”

Nadler offered me a distinction.

“I divide the population of affected people in different ways,” he says. “First are the ones that were killed, and you can blame the terrorists for those. Then there was the plume—we think about 30,000 people were caught in it. And those people were also sickened by the terrorists. But the others are first responders on the pile, and most of those are sick due to exposure—there you can blame public officials who permitted them to work on the pile.” Nadler also includes area residents and workers among the victims of public officials.

During the hearings, Whitman acknowledged that some first responders were sickened by the contamination because they did not wear respirators.

“After the first three days, it is not a rescue operation,” Nadler says. “It is simply a cleanup, and there is no excuse for not doing it properly. At the Pentagon site, nobody got sick there because they enforced the safety laws.” Workers who did not comply with safety regulations were not permitted on-site at the Pentagon-run cleanup.

“Every action taken by the EPA during the response to this horrific event was designed to provide the most comprehensive protection and the most accurate information to the residents of Manhattan,” Whitman stated in a press release. Her remarks, however, only served to enrage already traumatized New Yorkers.

Through a spokesperson, Whitman declined to answer any questions for this article, instead offering a prepared statement citing her congressional testimony.

“It is clear there are laws and regulations that were in place, which, had they been followed, would have prevented all this,” Nadler says. “They weren’t followed.”

While the courts try to determine who is responsible for the environmental debacle following 9/11, countless New Yorkers continue to live and work near Lower Manhattan with the assumption that it is safe. The dust is now out of sight, out of mind, and possibly in their lungs, hearts, and bloodstreams.

End

Just an FYI… the NYTimes came out with what appears to be a “hit piece” today with regard to the Toxic Dust. The “Debunkers” have jumped on it of course. Soooo… there aren’t policemen and firemen walking around with mobile respirators? There aren’t over 100 people that died that just happened to be down at Ground Zero? Coincidence? Is this all a figment of my imagination? The “Debunkers” have stooped to a new low. Even though they say that they “hope and pray that working on the pile did not lead to longterm problems for a large number of the people involved, but that’s just hoping for the best for them, not the best for us” in their “debunking”, the “debunking” itself, at least to me, is like attacking the heroes of 9/11. They would step on the sick and dying responders just because of one article, completely ignoring the years of other articles that substantiate what we’re saying, just to try and make us look bad. Way to go guys. You should be proud.

Rally for 9/11 bill to treat ailing first responders, residents

http://www.newsday.com/news/local/wire/newyork/ny-bc-ny--attacks-health0908sep08,0,5950142.story

3:13 PM EDT, September 8, 2007

NEW YORK (AP) _ Politicians and labor leaders gathered Saturday at ground zero to support federal legislation aimed at providing medical coverage to first responders and others afflicted by toxic dust and debris after the World Trade Center attack.

The rally was timed to coincide with the upcoming sixth anniversary of the attacks, when three members of New York's congressional delegation will introduce the bipartisan 9/11 Health and Compensation Act. Democrats Carolyn Maloney and Jerrold Nadler, along with Republican Vito Fossella, will bring the bill to Congress on Tuesday.

"The heroes of 9/11 responded immediately when our country was attacked, but when these same heroes needed help, our government dragged its heels," Maloney said. "Thousands are sick and that's a fact."

The bill would cover first responders and rescue workers, construction workers and volunteers from the nine-month cleanup of the rubble from the twin towers. It would also provide health monitoring and treatment for local residents, students and others who were in lower Manhattan after the attacks.

Joining the politicians were representatives from the New York City Central Labor Council, the New York Building & Construction Trades Council and the New York State AFL-CIO.

"We will not forget," said U.S. Sen. Hillary Clinton. "We're going to rescue the rescuers."

6 Years Later, 9/11 Health Questions Linger

http://www.forbes.com/forbeslife/health/feeds/hscout/2007/09/11/hscout608085.html

09.11.07, 12:00 AM ET

TUESDAY, Sept. 11 (HealthDay News) -- No one doubts the impact of the Sept. 11, 2001, World Trade Center disaster on rescue and cleanup workers' hearts, lungs and minds.

First, workers inhaled a toxic cocktail of soot, metals and other particles deep into their lungs during 12-hour shifts that lasted for weeks. There was also the psychological toll the cleanup effort took -- especially on those least prepared to deal with it.

"There were quite powerful stories of workers who would receive a load of debris and be dumping and find, for example, a human hand in it. And then not to be able to adequately process what it was that they were experiencing," said Alison Geyh, an environmental health scientist at Johns Hopkins University who spent weeks at the site -- an experience she said often left her shaken.

When it comes to the long-term health impact on workers, however, nothing remains certain, despite numerous highly publicized reports from government and private agencies.

"It's a real commentary that here we can have the largest manmade catastrophe of this sort for which we have so little environmental data," said Jeanne Stellman, now a professor of preventive medicine at the State University of New York Downstate Medical Center, in New York City.

"That's really a sad commentary on how we handled it," said Stellman, who took part in a landmark Mount Sinai Medical Center study as the deputy director of Mount Sinai's Selikoff Center for Occupational and Environmental Medicine in New York City.

The study released by the center just before the five-year anniversary of 9/11 found that 69 percent of 9,442 responders examined reported "new or worsened respiratory symptoms."

Almost half -- 46.5 percent -- of responders suffered more serious lower respiratory symptoms, including phlegm-laden "World Trade Center cough," the study found. Just under 63 percent said they have suffered from milder symptoms since cleanup wrapped up in April 2006, such as itchy eyes or runny noses.

And at least two people have died from illnesses experts have linked to 9/11 exposures. Felicia Dunn-Jones, a 42-year-old lawyer, succumbed to a disease resembling sarcoidosis five months after the attacks, and James Zadroga, a 34-year-old New York City police detective, died of pulmonary disease early in 2006.

Other studies have also suggested at least short-term respiratory effects, including a New York City Department of Health study released last month that found first responders to the attack now have a risk for asthma that is 12 times that of the general population.

But the available data may never be adequate to reveal the whole picture, experts said.

"First of all, we know nothing about the types of contaminants that were present in the days following the event, because there was no monitoring in place," Geyh said.

Her team's study, published in May in the New England Journal of Medicine, found relatively high levels of fine particles under 2.5 micrometers in diameter in air samples taken at Ground Zero in late September and October, 2001. These tiny particles can lodge deep in the lungs, potentially causing health problems for years to come.

Geyh said the U.S. Environmental Protection Agency wasn't able to install air monitoring equipment at the Trade Center site until near the end of September 2001. And she stressed that no one sample can ever give an adequate picture of the overall air quality. "It varied day to day," she aid. "We hypothesize that that had to do with how aggressive the fires were burning, or how aggressive the debris-removal activity was occurring."

Stellman, who has testified before the U.S. Senate on Ground Zero air quality and the clean-up effort, said getting a fix on the exact level of contaminants any one worker might have been exposed to will be nearly impossible. "The air changed from moment to moment, place to place, day to day," she noted. "We only have a small number of measures as to what was there."

Worker's level of protection varied too -- something Geyh said she witnessed firsthand. A variety of masks -- everything from the plain white ones commonly sold, to more sophisticated half-face, canister-equipped versions -- were often available, she said. But workers got little direction on how to use them or which mask might be best for their particular level of exposure. "It was very clear to us that that information was not easily found by the people who were supposed to be wearing the mask," Geyh said.

Another expert pointed to the discord that exists between EPA air samples and those garnered by private testing firms. Those firms were hired by banks and other corporations to test whether it was safe for workers to return to their lower Manhattan offices in the weeks after 9/11.

Those private environmental testing services "found a list that was longer in terms of contaminants, and in higher concentrations, for weeks afterwards and possibly even for longer," compared to EPA readings, said Dr. Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City. "There's a conflict of the information that we got at the time and what private companies were getting."

Stellman refuted that argument, however, saying that Horovitz was comparing "apples and oranges." She said that while the EPA was taking samples of outdoor air quality, most of the sampling done by the private firms was done inside buildings.

"It's very hard to make these comparisons because the EPA, I don't believe, had a lot of indoor air quality data," Stellman said.

But criticism of the Mount Sinai research program continues. In a Sept. 7, 2007, article in The New York Times, a number of critics charged that the findings from the Selikoff center -- founded in the 1980s with political backing from labor unions -- are biased in favor of boosting the number of workers thought to be affected by contaminants.

The center's supporters -- including Stellman -- shot back that the Mount Sinai team's efforts were stymied early on by a lack of federal funding and the government's emphasis that worker health screening, not research, be the focus of their efforts at the site.

So, questions on the long-term health effects of those weeks of grueling work at Ground Zero remain unresolved and may never be resolved due to a paucity of data, the experts said.

"What we don't know certainly weighs much more heavily than what we do know," according to Horovitz.

One thing scientists do understand, he said, is that particles under 2.5 micrometers can lodge in the lungs' tiniest channels for years, potentially causing lung disease, atherosclerosis ("hardening of the arteries"), and even cancers.

Many of these illnesses may not show up for decades. "It is definitely far too early to know what's coming down the road for cancer, for example," Stellman said.

She believes it may never be certain whether Ground Zero exposure was carcinogenic. "Because, tragic and horrifying as [9/11] was, the population exposed may never be big enough [statistically] to actually give us a definite answer," Stellman explained.

The psychological consequences for workers are becoming increasingly clear, however. In another New York City health department report, released in August, researchers found that one in every eight responders and workers has come down with post-traumatic stress disorder (PTSD).

Risks for the troubling condition appear to correlate with the length of time workers spent at the Trade Center site, how soon they arrived after the disaster, and their level of training in dealing with traumatic events, the study found.

All of the data, on both mental and physical health, does point to one conclusion, the experts said -- that workers will need to be monitored and tended to for decades to come.

"They are the people who put themselves at risk to help this country heal," Geyh said. "We should be vigilant to make sure that we understand what's going on with them."

Doctor details 9/11 workers' illnesses

http://news.yahoo.com/s/ap/20070912/ap_on_he_me/terror_attacks_health

By DEVLIN BARRETT, Associated Press Writer
1 hour, 46 minutes ago

WASHINGTON - Doctors treating sickened ground zero workers offered Congress a detailed diagnosis Wednesday of the ailments still affecting thousands after the Sept. 11 attacks, but warned that there's no way to determine how many more may become afflicted with life-threatening illnesses.

Dr. Philip Landrigan of the Mount Sinai School of Medicine described three months of recent medical treatment to a House panel examining how many of those who toiled on the toxic debris pile are still sick — or may get sick.

Thousands of people "are still suffering," Landrigan said a day after the sixth anniversary of the Sept. 11, 2001 attacks. Their ailments range from runny noses to laryngitis to lung disease, he said.

"Respiratory illness, psychological distress and financial devastation have become a new way of life for many," he told the House Education and Labor Committee. He advocated leaving Sept. 11-related medical programs in place to try to determine how many workers might develop long-term diseases.

Patricia Clark, a regional official with the Occupational Safety and Health Administration, said workers who were exposed to ground zero toxins in the first 48 hours after the attacks were hit with an "incredible assault" on their health. Still, she defended her agency's air sampling, which found little evidence of dangerously high levels of asbestos and other contaminants.

The figures offered Wednesday further define the medical problems found by a 2006 Mount Sinai study, which said 70 percent of ground zero workers suffered new or worsened respiratory problems after their exposure to the debris of the World Trade Center.

Landrigan offered new specifics of the most prevalent symptoms among the police officers, firefighters, construction workers and volunteers examined.

Between April and June of this year, doctors in the 9/11 workers health program overseen by Mount Sinai saw 2,323 patients.

They found:

_Lower respiratory problems in 40 percent of patients. Asthma and asthma-like reactive airways disease were found in 30 percent. Smaller portions of patients had chronic cough — 7 percent — or chronic obstructive pulmonary disease — 5 percent.

_Upper respiratory conditions in 59 percent. The most common condition was runny nose, in 51 percent of the workers, and chronic sinusitis, in about a fifth of them.

_Mental health problems, the most common being post-traumatic stress disorder and depression, in 36 percent of patients.

Landrigan said it is still unclear how many of those patients will continue to experience such symptoms, or how many may develop new diseases like cancer many years after their exposure.

Lingering 9/11-related illnesses — and deaths of some first responders years after the attacks — have led to calls in Congress for a federal program to fund long-term health programs for those workers.

So far, the government has paid for piecemeal screening and treatment of emergency personnel, construction workers and volunteers, but advocates want such programs expanded to include lower Manhattan residents, students and tourists.

9/11 Health Problems Demand Less Talk, More Action

http://blog.wired.com/wiredscience/2007/09/911-health-prob.html

(Gold9472: Way to go Brandon.)

By Brandon Keim
September 14, 2007

911 "Respiratory illness, psychological distress and financial devastation have become a new way of life for many" 9/11 cleanup workers and first responders, Mount Sinai School of Medicine doctor Philip Landrigan told a Congressional committee yesterday. As reported in the Associated Press, 70 percent of the workers "suffered new or worsened respiratory problems after their exposure to the debris of the World Trade Center. The majority suffered from so-called lower respiratory problems -- wheezing, shortened breath, chronic coughs -- that are seen as indicators of serious health problems.

The New York Times recently discussed the work of Landrigan and his colleagues, who work at Mount Sinai's Irving J. Selikoff Center for Occupational Health and Environmental Medicine. After 9/11, the clinic's doctors "stepped into the fray in the absence of any meaningful effort by the city, state or federal government to survey, interview or offer treatment to potentially sickened recovery and cleanup workers." But the clinic has historically strong ties to organized labor, and critics say that it has favored advocacy over strong science, and that the epidemiological data it's provided is patchy and haphazard.

There's probably an element of truth to that, particularly the latter charge: with a tiny budget, no time to plan and just six full-time doctors, the clinic embarked on an "unprecedented epidemiological challenge." Its data isn't as rigorously parsed as it ought to be. In the future, more studies will be needed in the wake of natural and man-made disasters to document their public health effect. But as far as the health of people who breathed the foul post-9/11 air is concerned, the critics are missing the forest for the trees. Data doesn't have to be perfect to be useful, and as patchy as it may be, there's enough to show that a great many people inhaled high levels of burning toxic compounds, and it appears to have harmed them. As the AP notes,

Lingering 9/11-related illnesses and deaths of some first responders years after the attacks have led to calls in Congress for a federal program to fund long-term health programs for those workers.

So far, the government has paid for piecemeal screening and treatment of emergency personnel, construction workers and volunteers, but advocates want such programs expanded to include lower Manhattan residents, students and tourists.

That this should even be debatable is disgusting.

http://home.businesswire.com/portal/site/google/index.jsp?ndmViewId=news_view&newsId=20070916005058&newsLang=en

September 16, 2007 07:30 AM Eastern Daylight Time

Retired NY Giants Great George Martin Begins ''a Journey for 9/11''

3,200+ Mile Cross-Country Trek from George Washington Bridge to Golden Gate Bridge Will Benefit Thousands of Sick WTC Rescue and Recovery Workers

NFL Alum, AXA Equitable Executive Embarks on Four-Month Journey; Seeks to Raise $10+ Million for Ground Zero Workers Now In Severe Medical Distress

NEW YORK--(BUSINESS WIRE)--Retired New York Giants co-captain and Super Bowl champion George Martin will embark today on a physical challenge far more demanding than an NFL training camp when he begins a 3,200+ mile fundraising walk across the United States to benefit sick Ground Zero rescue and recovery workers. The walk, called “a Journey for 9/11,” (www.ajourneyfor911.info) is expected to take approximately four months, and will start at the George Washington Bridge in New York City and end at the Golden Gate Bridge in San Francisco. Mr. Martin seeks to raise awareness about these health issues and more than $10 million for 9/11 workers who are suffering serious medical conditions related to their efforts at Ground Zero after the attacks of September 11, 2001.

“Thousands of people – first responders, volunteers, construction workers and so many others – unselfishly put themselves in harm's way for months after September 11, and they deserve the best medical attention available,” said Mr. Martin, now vice president of sports marketing for AXA Equitable, which has given him a leave of absence for his Journey. “We need to do as much as we possibly can for any of these workers who are now suffering medically because of their efforts. This Journey is one way I can make a difference, and I invite others to support our mission.”

George Martin was a star defensive end and co-captain of the Super Bowl Champion New York Giants (1986). In Super Bowl XXI, he famously tackled Broncos quarterback John Elway for a safety in the end zone. During his 14 NFL seasons (1975-1988), Mr. Martin scored seven touchdowns (three on interception returns), which set a record for defensive linemen. He is a former president of the NFL Players Association.

Inspired by a Neighborhood Loss

Mr. Martin feels a personal connection to the events of September 11. A New Jersey resident, two of Mr. Martin’s young neighbors perished in the terrorist attacks. In honor of them and the thousands of firefighters; police officers; EMTs; clergy; construction and other workers; and volunteers who helped dig through the rubble, he hopes to attract the attention of and financial contributions from Americans and businesses coast-to-coast as he treks through towns and cities across the United States for the next four months.

The Medical Problems of Working at Ground Zero

Medical studies now substantiate what many had suspected and claimed for several years – that working at Ground Zero led to serious, long-term medical problems for thousands of people. Studies indicate that 3.6 percent of WTC rescue and recovery workers reported developing asthma after exposure to dust and debris from working at the site, 12 times the rate of the normal adult population. And according to the NYC Department of Mental Health and Hygiene, one in eight of nearly 30,000 WTC rescue and recovery workers developed Post-Traumatic Stress Disorder, a condition found to be highest among WTC volunteers http://www.nyc.gov/html/doh/html/pr2007/pr076-07.shtml.

The Start of the Route

“a Journey for 9/11,” a not for profit charitable organization, commences on Sunday, September 16, 2007, at the New York side of the George Washington Bridge. After a brief ceremony there, Mr. Martin, volunteers, philanthropic donors, corporate sponsors and other supporters will join him as he treks across the famed bridge into New Jersey. He will then walk four plus miles to a ceremony at the Hackensack University Medical Center, which along with the North Shore-Long Island Jewish Health Systems and the Mt. Sinai Medical Center will match the total funds Mr. Martin’s Journey raises. From there Mr. Martin will walk to Giants Stadium, where he will be honored at halftime ceremonies during the Giants home opener vs. the Green Bay Packers. Legendary Giants alumni will help collect Journey donations from fans outside the Stadium, Mr. Martin will address the crowd and the team will show a career highlights reel to game attendees to give the former defensive end a formal send-off.

The Route and Journey Team

States on Mr. Martin’s Journey include New York, New Jersey, Pennsylvania, Maryland, Virginia, West Virginia, Kentucky, Tennessee, Texas, Arkansas, Oklahoma, New Mexico, Arizona, Nevada and California. On Friday, September 21, he will pass through Washington, DC, for a special event with the NFL Players Association.

The retired NFL great plans to walk approximately 50 miles each day: 12 ½ miles before breakfast, 12 ½ before lunch, 12 ½ in the afternoon, followed by a short rest, and then a final 12 ½ before dinner and bed. Mr. Martin, 54, has been training for more than three months for this endeavor.

Throughout his Journey, Mr. Martin will be accompanied by one security officer and a support team that includes an advance person; a technology specialist who will document the Journey; a medical technician; and a driver, who will drive the team’s accompanying motor home.

Support from Business, Medical, Education, Sports and Charitable Community

Sponsors of the Journey include Hackensack University Medical Center; North Shore-Long Island Jewish Health Systems; Mt. Sinai Medical Center; Fairleigh Dickinson University; United Parcel Service; Bear Stearns; Nike; TanaSeybert; Keyspan Energy; Hunter Douglas; the New York Giants; the National Football League; the National Football League Players Association; General Motors; Sprint and World Wrestling Entertainment. Philanthropists Joseph H. and Dr. Carol F. Reich led the way with a donation today of $911,000.

“I'll walk every mile of the route, and will enjoy meeting this challenge; no walking a few miles and then riding in a car,” said Mr. Martin. “Outside of family, this is the most important thing I have ever done in my life.”

Donations

To make a tax deductible financial donation to “a Journey for 9/11,” visit http://www.active.com/donate/aJourneyfor911; or write to “a Journey for 9/11,” Rockefeller Center, P.O. Box 4862, New York, NY 10185-4862; or call 888-702-5080.

For general information about a Journey for 9/11, visit www.ajourneyfor911.info.

http://www.active.com/donate/aJourneyfor911

If this website is correct, this guy has already generated over $1 million in donations.

Some of the top contributors:

The Jim Fassel Foundation $25,000.00 WWE . $10,000.00 Bill Parcells $10,000.00 Lee Reeves In Loving Memory - Minnie L. Reeves $5,000.00 Inc. Man Etc. $2,500.00 Pamela Duffy $500.00

Giants Star Martin Begins 9/11 March

http://ap.google.com/article/ALeqM5iE9IpV7kQcZeFgEEdfkkmaHjnt_w

1 hour ago

NEW YORK (AP) — Saying he knows what real heroism is, former New York Giants star George Martin began a cross-country walk to raise money for ailing ground zero workers.

A captain of the 1987 Super Bowl champions, Martin was cheered on by a few dozen volunteers Sunday as he stepped onto the pedestrian walkway of the George Washington Bridge, which connects Manhattan and New Jersey.

"I've been termed a hero for playing a kids' game at a pro level, and that does not rise to the level of heroic," Martin said Saturday as he got ready for his journey. "I think of 9/11, when I saw people respond and put their health, their careers, their lives in jeopardy."

Walking briskly, he hopes to cover at least 30 miles a day in a march that, if all goes well, will end at San Francisco's Golden Gate Bridge in about four months.

Martin said he was moved by the stories of World Trade Center rescue and recovery workers who began getting ill years after the terror attacks. There is evidence that some illnesses may be linked to the toxic dust of the twin towers.

He hopes the walk will raise $10 million.