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Testimony by
Henry Falk, M.D.
Assistant Administrator,
Agency for Toxic Substances and Disease Registry
Public Health Service
U.S. Department of Health and Human Services
Before the
Committee on Environment and Public Works
United States Senate
Fallon, Nevada
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 (ATSDR).

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 involvement.

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 substances.

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 disease tracking.
  • 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