Thursday, August 03, 2006

'Not Getting Better': A new study finds serious lung problems among thousands of 9/11 responders

'Not Getting Better'
A new study finds serious lung problems among thousands of 9/11 responders.
By Jennifer Barrett

Aug. 1, 2006 - It’s no surprise that many of the responders and volunteers who spent days—sometimes months—at the World Trade Center after the terror attacks on September 11, 2001, have reported physical and psychological after-effects. Ailments ranging from insomnia to post-traumatic stress disorder to various respiratory problems have been diagnosed in both responders and in residents who lived or worked in the immediate vicinity of Ground Zero. Still, with so many people exposed to the resulting toxins and at different levels, it's been difficult to demonstrate a causal link between time spent at the site and specific health problems suffered afterwards.

A new study published in the August issue of the American Thoracic Society's journal, the American Journal of Respiratory and Critical Care Medicine, aims to do just that. Researchers compared lung-function data compiled by the New York City Fire Department for 12,079 of its firefighters and emergency personnel for the four years before the attacks and one year after. All of those included in the study were directly exposed to the toxic cloud that enveloped Ground Zero after the twin towers collapsed—arriving either before the collapse or in the days immediately following. The result? Researchers found that in the year after the attacks, the firefighters who'd spent time at Ground Zero suffered a decrease in lung function capability equal to 12 years of age-related decline. What could this mean for the long-term health of the estimated 40,000 police, firefighters and other workers who came to the site to assist in rescue and recovery efforts? NEWSWEEK's Jennifer Barrett spoke with the study's lead author Dr. Gisela Banuach, a pulmonary and critical care physician at Montefiore Medical Center in New York. Excerpts:

NEWSWEEK: What is the most significant aspect of these findings?
Dr. Gisela Banauch: I was surprised at the extent of the breathing capacity loss—12 years is a lot. Another aspect that makes it very solid from a research perspective is that we are comparing data from the same person before and after 9/11. Usually that's not possible. But the Fire Department performed periodic medical examinations before 9/11. Also, the exposure intensity response gradient is unique. We grouped people by exposure: high, moderate, and less exposed. So we can show that the same person had normal breathing function before and then it dropped [after spending time at Ground Zero] and that those with high exposure had a more intense response than those with less. That is very suggestive of causal relationship.

What about those who smoked, or had respiratory problems, before the attacks?
We considered all the factors that can influence breathing capacity like gender, race, age, height and smoking. We had to get all of this into one database then compare the before-9/11 measurement to after-9/11 measurements. We only used the year after 9/11/2001.

Have you analyzed data from the same group from 9/11/02 through the present?
I have not seen it yet, but there is more data now on the nearly five years following 9/11. We will follow up.

What do you expect to see?
With long-term measurements, what you will always see when you have a situation like this is that the sickest ones are the ones who are most likely not to show up for repeat exams because they get too sick or they die.

Did that happen in this study?
Death has not been a big factor yet. But you can get this “healthy worker effect,” where the healthiest people are those who show up for repeat exams while those who are sicker or who have died are not included. The cost of living is also high here [in New York]. So the sickest ones have retired or may retire and move away because it is too expensive to stay here. So you think that there's not too much of a problem anymore, when that is not the case. It's not necessarily because the problem went away, but because the people have gotten so sick they don't come for measurements anymore. That's not so much of a problem for the first year but it could affect the 2-5 year period after 9/11.

Do you think the health problems you noted in this study—asthma, chest pains, diminished lung capacity—will be evident, or even worse, in the follow-up study?
I think there will be some persistent problems. It'd be foolish not to think so. This is not to say that everyone who had problems initially will have problems now. But a number of workers are not getting better.

I have followed about 151 workers more closely [who were not part of this study] who were there when the towers collapsed or in the following two days. I know some who didn't want to face up to the fact that they were sick in the first year. Now they are worse; they have to take medications. Then some didn't develop a real problem on the breathing tests until one year later. One man I have followed never had any asthma and now it is horrendous. He is still feeling very sick and he's on all these medications. Others got treatment early on and are feeling better.

What other health problems have you seen emerge over the long term in the small group you've been following?
It's more anecdotal. I don't have specific numbers, but I have seen more than lower airway problems like asthma and reactive airways syndrome. I've seen upper airway problems like sinus problems, obstructive sleep apnea and reflux problems like acid indigestion and heartburn. It makes sense because people inhaled an abundance of dust and swallowed parts of what they inhaled. We've seen inflammation in the stomach and esophagus.

Are any of these problems life threatening?
The symptoms themselves, no, but the diseases even four years out, yes. I have seen those in my group that I'm monitoring. One has very bad, life-threatening asthma. I think we'll see deaths related to this in the future. Maybe not in five or 10 years, but in 20 years.

The study notes that many responders didn't have proper protective equipment. Was that because the masks weren't available or because the firefighters wrongly assumed the air was okay?
It's probably a combination of both. The fire department did not plan for this type of environment because it is really geared toward fire emergencies, not to building site emergencies and collapses. Proper equipment was not immediately available. In my personal opinion, I think that there would have been some protection from even a basic air mask. But I was down there and no one was wearing them. Their use was enforced later, but it took a couple weeks.

What can this study tell us about the tens of thousands of others exposed to the toxic plume on and after 9/11?
It's difficult to draw parallels because other residents and other workers around there were not present for such a length of time and right on the pile as these firefighters were. There's something called the threshold effect with exposure—below which you may not see any kind of change in health or sickness. We're not sure if you needed to have a certain dose accumulated before there was a health effect. Obviously, a resident who looked for a neighbor for three weeks down there [at Ground Zero] probably had exposure just as bad as a firefighter paid to work down there. But on a group basis, it's hard to draw parallels.

What should be done now?
We have to have more monitoring of those who were exposed—and do it for a long time. With chronic obstructive pulmonary disease, for example, you'd need to monitor it for a decade to start documenting deaths from it. Some of these problems can develop over decades, so the symptoms have probably emerged, but not necessarily the changes in lung function. I think there was a delay between many people getting the symptoms and realizing it was something that's not going away and could be connected to 9/11. And we have to raise awareness within the medical community about this. Some may have concluded that since the symptoms have improved, everyone is doing better. But that is not the case.