Henry Falk, M.D.
Agency for Toxic Substances and Disease Registry
Public Health Service
U.S. Department of Health and Human Services
Committee on Environment and Public Works
United States Senate
April 12, 2001
Good afternoon Mr. Chairman and members of the committee. My name is Dr. Henry
Falk, Assistant Administrator of the Agency for Toxic Substances and Disease Registry
Thank you for inviting ATSDR to speak with you today. We share your concerns about
the health and well being of children and families in Fallon and across the country. We
also share your desire to adequately address the concerns expressed about illness and
disease that might be associated with the environment. In fact, addressing these types
of concerns is at the root of ATSDR's creation.
ATSDR is a federal agency created by Congress in 1980 by the Comprehensive
Environmental Response, Compensation, and Liability Act (CERCLA), or what is more
commonly known as Superfund legislation. As such, ATSDR is the public health
agency charged with determining the nature and extent of health problems at
Superfund sites including federal Superfund sites, and advising the US Environmental
Protection Agency (EPA) and State health and environmental agencies on needed
clean-up and other actions to protect the public's health.
ATSDR works in close collaboration with the EPA, other federal, state, local, and tribal
governments, health care providers and affected communities. As an agency of the
U.S. Department of Health and Human Services (DHHS), ATSDR has made a
difference to all of these partners by providing new information to assist in remedial
decision-making and evaluation. Our work includes answering the health questions of
impacted community members, recommending preventive measures to protect public
health, and providing diagnosis and treatment information to local health care providers.
ATSDR administers public health activities through: partnerships; public health
assessment and consultation activities; exposure investigations; health studies and
registry activities; development of toxicological profiles and attendant research;
emergency response; health education and health promotion; and community
ATSDR works in particularly close coordination with our DHHS sister agency, the
Centers for Disease Control and Prevention. Jointly we have worked with the Nevada
Health Division to investigate the cancer cluster in Fallon. For our part, ATSDR will
assist in the investigation by reviewing all relevant environmental data for toxic
substances and assessing whether people have been exposed to any of these
contaminants at levels of concern.
Unfortunately, the cancer cluster in Fallon is not a unique situation. Increasingly,
ATSDR is being asked by state and local health departments to help respond to
compelling community concerns about apparent outbreaks of serious, noninfectious
disease with unknown cause. As a small agency, responding to these requests would
be impossible for ATSDR alone. To supplement our own staff, ATSDR works in close
collaboration with state health departments, and has been funding environmental public
health activities in states since 1987. ATSDR currently funds public health activities in
28 states through separate cooperative agreements that provide assistance to conduct
public health assessments, health education activities, and epidemiologic studies.
Because of our Superfund mandates, most of our cancer cluster investigations and
assistance are related to concerns about Superfund sites, hazardous waste, and
exposure to toxic substances.
The site work we do directly or through our state partners has changed over time. Our
original mandate under Superfund called for public health assessments at all National
Priorities List (NPL) sites - and these originally constituted the great majority of our
workload. While we still actively work at NPL sites, it now constitutes a smaller
proportion of our site activities. Increasingly, our site work now is at immediate removal
sites, active waste sites, occasionally Brownfields sites, and, like Fallon, sites where
communities, states or Congressional officials have petitioned ATSDR to investigate or
assist in evaluating their health concerns related to toxic substances.
Activities related to the vermiculite mine in Libby, Montana, provide a very good
example of a current site where ATSDR's work has made a difference. The situation in
Libby offers a dramatic example of past exposure resulting in serious disease. In 1999,
reports from Libby documented cases of non-occupational asbestos-related pulmonary
impairment among family members of former mine employees as well as others in the
community with no connection to the mining operations. They were suffering (or dying)
from asbestosis, mesothelioma, and lung cancers related to their asbestos exposure.
Finding non-occupational asbestos-related pulmonary disease is extremely unusual and
suggests that dangerous levels of asbestos exposure have occurred within the Libby
community. The latency period for mesothelioma, for example, is 40 years. This means
that the health care community could be seeing the effects of exposure to asbestos-contaminated vermiculite from Libby for an entire generation.
In 2000, ATSDR conducted a medical testing program to assess the public health
implications of past human exposure to tremolite asbestos in Libby. More than 6,100
Libby-area residents and former mine workers were screened. This number included 70
from Elko, Nevada, who met the screening criteria for Libby. They all answered an
extensive questionnaire about their possible exposures and received both chest x-rays
and pulmonary function tests.
ATSDR recently reported a preliminary analysis of the medical testing results from the
first 1,078 participants, or 18% of the total number of participants in the medical testing
program. These results showed a very high percentage of individuals reporting contact
with the vermiculite, and evidence of health impacts, particularly in the form of
thickening and scarring of the outer pleural lining of the lung.
ATSDR will soon complete the evaluation of the Libby medical screening program and
is working with local, state, and federal health care providers to address health issues
that are identified. Specifically, to help local residents obtain medical care, ATSDR has
worked closely with the DHHS Regional Administrator and other DHHS agencies such
as the Health Resources and Services Administration (HRSA) and the State of Montana
to ensure appropriate treatment is available.
ATSDR and CDC are reviewing and responding to the Pew Environmental Health
Commission Report. The report recommends strengthening federal, state and local
public health capacity to tackle environmental health problems and establish a
Nationwide Health Tracking Network on chronic diseases and related environmental
hazards. ATSDR has made significant progress in developing registries of individuals
exposed to specific substances and tracking them over time to assess health status
and provide updated information over time to exposed individuals. At the request of
Sen. Baucus (D-MT) and others, we plan to establish a registry of vermiculite exposed
individuals from the Libby area. The agency also has considerable experience working
with state health departments and communities to conduct epidemiologic investigations
of specific health outcomes in communities near environmental sources of hazardous
In keeping with the Superfund mandate to ". . .establish and maintain a national registry
of serious diseases and illnesses. . .", we at ATSDR see ourselves as having a direct
responsibility under CERCLA to participate with CDC and others in developing disease
surveillance or tracking systems, particularly for diseases with known or potential
relationships to hazardous waste and toxic substances. In addition, because of our
close working relationship with EPA, we are interested in how to link environmental
databases with developing health tracking data. Although we are very far from a
comprehensive system at this point, ATSDR does have some ongoing, albeit limited,
efforts underway as part of our Superfund work. These include an epidemiologic study
investigating the cause of childhood cancers in conjunction with Superfund sites in four
states, and a pilot program to develop health tracking of multiple sclerosis in a number
of circumstances where concern about the frequent occurrence of this disease arose in
relation to adjacent hazardous waste sites.
But we recognize that much more needs to be done. Mr. Chairman, the public naturally
becomes concerned when they see situations such as half of a class of third graders
needing to bring asthma inhalers to school, or when persons compare notes about their
first diagnosis of multiple sclerosis at a 20 year high school reunion, or when multiple
parents within the same neighborhood watch their children suffer from brain tumors and
other severe illnesses, or when women who do not smoke and who did everything right
during their pregnancy give birth to small or sick babies. Sadly, in a country as large as
ours, these unusual occurrences are not so unusual at all. All over the country, citizens
turn to their local, state and federal health authorities and ask what could be causing
these and other types of clusters of health problems. In communities near obvious
sources of environmental contamination, people understandably worry that somehow
environmental pollution might be playing a role.
At ATSDR we are committed to doing what we can to address these very real concerns.
- As I've stated earlier, we are working every day at sites around this nation to
address the health concerns of communities affected by toxic exposures.
- We are working with our colleagues at CDC to address the issue of health and
- And, we continue to strengthen our ongoing partnerships with Federal, state and
local agencies, which is integral to answering these questions.
Mr. Chairman, on a personal note, I started my professional career as a pediatrician at
the Centers for Disease Control in 1972, and my first investigation was of a leukemia
cluster in Elmwood, Wisconsin. I did several more such investigations over the next 18
months, none of which revealed an obvious cause for the clusters. However, my fourth
or fifth such investigation was of 4 cases of liver cancer in a factory which turned out to
be the first reported cases of vinyl chloride induced liver angiosarcoma in polyvinyl
chloride polymerization workers. This subsequently led to much improved and safer
working conditions for the entire industry worldwide. I have seen how agonizingly
frustrating this work can be; but I also feel that if we are in the mode of carefully
scrutinizing health data, then we will be positioned correctly to detect new problems
when they arise.
Mr. Chairman this concludes my testimony. I will be happy to answer any questions
that you or members of your committee might have.
Last revised: May 30, 2001