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‘WTC cough’: time to draw breath

A large study was widely reported as confirming that Ground Zero workers may have been poisoned by toxins. Some healthy scepticism is required.

Todd Seavey

Topics Politics

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The largest study yet of workers who participated in the rescue efforts and clean-up at the site of the World Trade Center attack has been reported as evidence that a spectrum of mysterious health problems were caused by the fumes from the disaster. In a sense that’s true, in that we don’t know the precise nature and cause of all the respiratory ailments reported five years later by participants in the study. But that is partly a function of the study’s strangeness rather than the fumes’ strangeness.

Just as the media and politicians should take care not to heighten terrorism’s impact by exaggerating the risk it poses to the public, so too should we be cautious about making an already-nervous population think they have been ‘poisoned’. This does not mean that WTC-related respiratory problems – sometimes referred to as ‘WTC cough’ – are non-existent or that the clean-up workers did anything less than a heroic job by sorting through the Hell-on-Earth that was Ground Zero in September 2001. But we have an obligation to weigh the facts cautiously.

The new study, from Mount Sinai Medical Center, published in Environmental Health Perspectives, should immediately send up some red flags in the minds of sceptics. For one thing, the study is based on reported lingering respiratory problems of a somewhat subjective nature: chest tightness, shortness of breath and dry cough, which are to some extent things that could be exacerbated by stress or more emphatically reported due to stress.

Second, though the report is only being released as I write this, it will be interesting to see if its future critics – and those attempting to replicate its results – discover some selection bias at work in the creation of Mount Sinai’s worker cohort (this is only an example of a possible problem and may not prove in the long run to be a decisive one). Since government spending on special health measures for the Ground Zero workers has been a hot-button political issue – as the Mount Sinai scientists doing the study well know – the scientists have been eager to stress the financial dire straits of the workers in their study. As Dr Robin Herbert, co-director of Mount Sinai’s World Trade Center Worker and Volunteer Medical Screening Programme, told the New York Times, ‘Our patients are sick, and they will need ongoing care for the rest of their lives’ (such a confident long-term projection about ostensibly mysterious illnesses is itself a troubling sign that there is something more than scientific objectivity at work at Mount Sinai). But in stressing the neediness of Ground Zero workers, Mount Sinai inadvertently draws attention to the fact that their cohort of workers is an unusual one in at least one way: a full 40 per cent of them are reportedly lacking health insurance.

A Census Bureau study released the same week as the Mount Sinai report shows that only 16 per cent of Americans lack health insurance. The Mount Sinai study reported a doubling – to 28 per cent – in the number of people reporting breathing problems among Ground Zero workers in their study relative to the number among the general population. Might the stress of being without insurance itself increase the frequency of self-reported breathing difficulties? This is made more likely if the breathing difficulties are defined broadly enough that some 13 per cent of the general American population report such problems, as the study says. The percentage of the general population reporting severe lung impairment or other more clearly physically-measurable problems would be far lower. Socioeconomic considerations are not a vague excuse to dismiss the workers’ complaints, but we know, for instance, that asthma rates are substantially higher among New York City poor than among the general population, without knowing exactly why.

It would be unsurprising, of course, if the Ground Zero workers, who were exposed to, among other things, clouds of broken glass particles, have some real problems. Even if those problems are occurring at something like the rate suggested by the Mount Sinai study, though, we should be cautious about leaping to the conclusion that toxic chemicals (rather than more mundane effects such as smoke inhalation) from the Twin Towers are to blame, which seems to be the favoured conclusion of study co-author Dr Philip Landrigan, a founder of the Mount Sinai screening programme.

Landrigan, a pediatrician and environmental health specialist, has blamed an array of health problems over the years on exposure to trace levels of chemicals in the environment, from developmental problems in children to dementia in the elderly. He has called for a complete restructuring of the US food regulatory system based on his belief that children are being harmed by pesticide residues on vegetables. In the ongoing medical evaluation of workers from Ground Zero, he has a globally-watched podium from which to repeat his message that the modern world is a deadly chemical soup from which we need protection.

And politicians have been eager to show that in this case, they will provide protection. Despite claims of government negligence – caused by quick assurances from normally quite risk-averse authorities after 9/11 that most New Yorkers had nothing to fear from Ground Zero fumes – politicians have in fact been rushing to prove their willingness to spend money on care for and further study of the Ground Zero workers. New York Senator Hillary Clinton is leading the way. Campaign ads for Clinton’s current Senate re-election campaign stress her effort to boost spending for Ground Zero workers, and even New York City’s somewhat more fiscally-restrained mayor, Michael Bloomberg, has combined his assurances that self-reported illnesses are not necessarily caused by Ground Zero with assurances that New York will spend whatever it takes to help workers and do further study anyway.

Bloomberg can’t afford to look uncompassionate in the current environment. He has to compete for attention with politicians such as Congressman Jerrold Nadler, who goes beyond wanting to help those exposed to the thick fumes at Ground Zero itself and fears lingering poisonous residues in New York apartments and businesses, saying ‘I am particularly troubled at the inadequate attention given to contaminated indoor spaces and chronic exposure populations.’ Worse, from a public relations perspective, Bloomberg has to compete with figures such as Sister Cindy Mahoney, a nun dying of lung disease who spent six months blessing human remains at Ground Zero and who says she wants her body autopsied to prove that her ailment was caused by being a Ground Zero worker. Perhaps she’s right, but one person, however beloved, does not a statistical analysis make.

Maybe future studies will reaffirm Mount Sinai’s conclusions, but there is reason to worry that an old and familiar formula in the creation of health scares may also be at work: when the government does not appear to its critics to be reacting quickly enough, all subsequent complaints – and even conspiracy theories – are readily accepted, out of guilt and the desire to avoid looking uncompassionate again. Disasters and highly emotional conflicts often have such side effects: Baghdad veterans have their mystery-illness claims, post-hurricane New Orleans is now rife with conspiracy theories about Republicans and real estate developers dynamiting the city’s levees to wash away poor residents (see When swing was again the thing, by Todd Seavey). And in a world where 75 American professors can be found willing to sign off on a statement that 9/11 was actually an inside job orchestrated by the US government (complete with a controlled demolition-by-explosives of the WTC), it would hardly be surprising if we soon hear charges that a conspiracy of silence is imperiling the health of poisoned Ground Zero workers.

At least the Mount Sinai researchers, politicians and common sense are in agreement that further study, not panic, is the rational course.

Todd Seavey is director of publications at the American Council on Science and Health, which has published reports on various terrorism-related health issues. Seavey’s thoughts on Ground Zero and architecture will be published as part of Reason.com‘s 9/11 round-up.

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Topics Politics

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