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Saturday, July 27, 2013

The Place Among the Pines

Jon Ericson was a scientist and pioneer in fields such as prenatal and early childhood health. His research found links between neurotoxins and behavioral disorders, environmental lead and ADHD, and other metals and ravages of modernity. We worked on a childhood lead study in south-central Los Angeles, a scaled-back version of his epidemiological projects in Mexico. He taught us research methods and encouraged us to learn geographic information systems. I remember him most for the stories he told and his warnings about the safety of mundane objects, including the pillow as toxic sink and daily dose of flame retardants. He was a kind man who was ahead of his time. I was sad to see him go. This summer, we lost another champion of environmental health, Senator Frank Lautenberg of New Jersey. Their shared concerns can steady us through the dizzying drudgery of toxic chemical reform.

The summer repeatedly brought attention to the need to update our chemical laws. National Pollinator Week began with 50,000 dead bees at a Target parking lot, victims of a whimsical-sounding insecticide called "Safari." The European Union banned yet another pesticide that posed an "acute risk to honeybees" in corn and sunflower fields. Farmworkers endured their own risks of acute pesticide poisoning, as FIFRA's Worker Protection Standard failed to safeguard even those who followed its restricted entry intervals and controls. "Pesticide drift," which was not well documented when the standard was updated, made the news again. Chemical plants ruptured and released toxins beyond their permit allotments. One in Geismar, Louisiana sent nearly sixteen tons of VOCs into the air, followed by the usual dance between state and citizen monitors. We debated the hazards of hundreds of millions of tons of coal ash, years after a risk assessment found that living within a mile of an unlined coal ash pond presents a one-in-fifty elevated lifetime cancer risk. The amount of crude oil released from the Deepwater Horizon blowout remained up for grabs, as was the relative toxicity of Corexit 9527 and 9500, dispersants that hid the spill from full view. And the Toxic Substances Control Act (TSCA), the heart of our chemical program, dead letter, "high risk of waste, fraud, abuse, and mismanagement," and grandfather of tens of thousands, soldiered on. Our psychological immune system has grown to handle these reports - we may not work a field, live near a plant, or subsist from a certain body of water. But in the nearly forty years since TSCA was enacted, much has changed that puts the lie to this sense of safety. Our ability to detect chemicals and track their movement in various media has improved, even as the etiology of certain diseases and why they might cluster prove stubborn. We recognize the sensitivity of vulnerable subpopulations, including children, to toxic exposure. And the Centers for Disease Control (CDC) and others are aware of new sites of contamination, toxic sinks that rival the dumps and fenced-off fields of old. It turns out that we are those sites.

The significance of these trends, and the role of Professor Ericson, Senator Lautenberg, and others in promoting them, is clear by the end of Toms River (2013), a masterful account of a residential cancer cluster that is unique because it has, by the terms of modern epidemiology, a known cause. The story begins in 1949, when dye makers, who learned to coax vivid colors from the carcinogenic constituents of coal tar, built a plant on a triangular, 1,350-acre parcel in the dense pine forests of New Jersey. Before they arrived, they perfected clandestine dumping along the Rhine, poisoned shallow wells in Basel, and fled rumors of bladder cancer among workers at facilities across Europe. In other words, they were ready to unleash hell.

But this is only one of the narratives that build and merge as decades of DIY pushpin mapping, incidence studies, and multi-million-dollar investigations of cancer clusters draw to a close in the central New Jersey town. You could say that the story also begins in 1527 (advent of the medical case history and case series reports), 1700 (Diseases of Workers and early industrial hygiene), 1775 (a cancer case is medically linked to pollution, or "soot"), 1837 (modern epidemiology emerges from a cholera epidemic), the 1840s (the dye industry takes hold), 1863 (The Malignant Neoplasms ushers in microscopic pathology), 1877 (first use of infectious disease epidemiology tools to confirm a cancer cluster), 1913 (a shift from observational to experimental cancer research touches off the search for carcinogens and yields a haiku: "Cancer was produced! Proudly I walk a few steps."), and 1950 (case-control, with its focus on lifestyle factors and attempt to remove chance as a confounding factor, becomes the gold standard of epidemiology). The science weaves its way through accounts of disease and the inexorable movement of toxic plumes toward the Parkway well field, where the town took much of its water.

The early environmental management antics of Toms River Chemical (later Ciba) and Union Carbide are on display, as are the regulatory blinders - slipshod county health surveys, a gap-filled cancer registry, slow testing that hid some results (e.g., radioactivity) and obscured others (e.g., which of 50,000 chemicals do we try to find?). In Toms River, a layer of purple sludge "doesn't exist" when it lacks one of the chemicals on a Superfund target list. A facility inspection is a nightmare endured as much as an enforcement activity: "The inspectors would climb down into the landfill pit and examine the drums up close...The stench was awful, and the drums, lined up in rows and lashed together by ropes, sat on a thick bed of jet-black sludge trucked over from the wastewater treatment plant." Agencies allow carcinogens to reach a public well field, so that they can run the contaminated water through a treatment system already in place. An old chicken farm, "a foul-smelling, snow-covered wasteland, with thousands of drums lying in open, muddy trenches near some abandoned trucks," sends a plume across miles and decades and bathes the book in existential terror.

Cancer clusters, whether real or random, are rarely noticed and even less likely to be studied. This was true in Toms River, even as the tragic stars aligned: identifiable sources of contamination, years of exposure to toxins that even included a tracer chemical (SAN trimer), and seven times the expected brain and nervous system cancers among young children. The providential turns and slow grinding of years that led to the completion of studies there are carefully documented in Toms River. But the key to the story lies in moments where threads of science, organizing, and bureacracy meet.

In one of those moments, we find Senator Lautenberg, sitting in a folding chair. The scene is a public presentation of the results of a case-control study. This was not a comprehensive look at the health of children in Toms River, by any stretch of the imagination. For one, science kept "arriving too late" to provide answers. Samples of Parkway well field water contained 261 "tentatively identified compounds," or TICs. They were not well understood by regulators. The National Toxicity Program began a bioassay for the toxicity of one of the compounds to assist in the Toms River investigation. The program was "not in the business of testing chemical mixtures." Its study drowned in complexity - one strain of rat was better for brain tumor testing but could not test for the appropriate leukemia, and Union Carbide gave the program only so much of the compound to test. Another study searched for biomarkers of disease in the blood of several dozen residents, but the science of molecular epidemiology was in its infancy and samples were taken years after the water contamination in Toms River peaked. This left the standard case-control, which over more than a hundred years grew to rely on interviews, expensive models of water distribution and air diffusion, and statistical tests. The state epidemiologist could not investigate all cancer types or all dates that were relevant to the town: the data, and the need to adhere to 95% confidence intervals, would not allow it. Still, the odds ratios that he calculated were high, particularly for prenatal exposure to Parkway well water. But the confidence interval fell below 1 for each odds ratio, except for one: leukemia risk among girls prenatally exposed. Senator Lautenberg was there when the results were presented in 2001. He heard the disappointment among mothers and fathers, and victims, whose stories were not embodied in the data and its analysis. He witnessed the vulnerability of children to toxic exposure, and the near-impossibility of linking even one of more than 150 different cancers to a cause after-the-fact. He knew about the promising use of biomarkers that, in Toms River, was still out of its depth. And he learned that one of the likely causes of childhood cancer in this part of his state was a chemical for which the government lacked basic toxicity data.

Lautenberg makes only two appearances in Toms River: at the presentation, and earlier to convince the state to use water filters at newly-contaminated wells. But his experience of Toms River seems to have become the DNA for several TSCA reform bills that he introduced in the years that followed. He sponsored the Kid Safe Chemicals Act in 2005, followed by several versions of the Safe Chemicals Act. Reading these bills, one cannot help but sense the influence of Toms River over their content. Much of the writing about the Safe Chemicals Act concerned how it would fix TSCA's major shortcomings: its burden of proof, safety standard (from "unreasonable risk" and its cost-benefit implications to "reasonable certainty of no harm"), standard of judicial review, and lack of testing for nearly all "existing" chemicals. But its text rails against more than TSCA. It also targets the broader forces that neutralize health claims in places like Toms River. Phil Brown and others dub this the "dominant epidemiological paradigm," which focuses on lifestyle factors and their statistical control, downplays the lived experience of disease, and ignores the structural and institutional factors that contribute to its onset. The groups that oppose it employ biomonitoring and personal exposure assessment, methods similar to those that the CDC uses to report on 212 chemical pollutants in our blood. The Safe Chemicals Act took steps to embrace this movement. It recognized aggregate and cumulative exposure, vulnerability, prenatal and early childhood health, and bioaccumulation, and encouraged the collection of biomonitoring data through a Children's Environmental Health Research Program. It went further. It called for EPA to identify and address twenty Toms Rivers, areas with disproportionate exposure to toxins. And it recognized our inability to link disease to toxins in widespread use, and introduced incentives to build the domestic green chemistry industry. 

Which brings us back to this summer. "Safe chemicals" has given way to an effort to construct "chemical safety." A new bill, co-sponsored by Lautenberg, was referred to committee in May. "Unreasonable risk" and "substantial evidence" have returned, along with strong preemption of state programs and immunity from tort claims. But the bill is most breathtaking in its near-complete erasure of the lessons of Toms River, the prescience of Ericson's childhood health research, and Lautenberg's prior focus on the limits of modern epidemiology. The Chemical Safety Improvement Act of 2013 invites an eerie exercise. Read it. Compare it to the Safe Chemicals Act. Find the omissions: vulnerable subpopulations, aggregate and cumulative exposure, bioaccumulation, biomonitoring, and hot spots are gone or fail to play a meaningful role. What you find are concepts that, in other corners of government and recent requests for information, are considered best available science. 

Posted by Gregg P. Macey on July 27, 2013 at 04:01 AM | Permalink

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