Polycythemia Meeting With Local Docs Raises Watchdog Hackles

Earlier this week, officials with the Pennsylvania Department of Health and the federal Agency for Toxic Substances and Disease Registry held the first in a planned series of meetings with physicians to share and collect information on the local incidence of polycythemia vera, which a recent PADOH study found to be elevated. The meeting took place Wednesday, Aug. 16 at Miners' Memorial Hospital in Coaldale and included eight local physicians and their support staff as well as representatives of U.S. Sen. Arlen Specter and state Rep. Dave Argall.

What was said there has angered local environmental health advocates, with one grassroots leader even expressing concerns about a possible "cover-up."

The meetings come in response to a request ATSDR received earlier this year from Dante Picciano, director of the Tamaqua-based Army for a Clean Environment. He asked ATSDR to investigate the unusual number of polycythemia cases clustered along Ben Titus Road north of Hometown in the Still Creek community, which is also home to the local drinking water reservoir. Still Creek is downhill from McAdoo Associates, a former toxic-waste incineration and dumping operation that's now a Superfund site. It's also near Northeastern Power's waste-coal-fired cogeneration plant (and the associated "Big Gorilla" coal combustion waste pit) and downwind of Air Products specialty gas plant -- all significant sources of pollution. (For more information on local pollution and its possible relationship to polycythemia, see my July 30 post, "Local Polycythemia Rate Gets Feds' Attention.")

According to the latest report from Picciano, informal surveys reveal that at least seven residents of Ben Titus Road have been diagnosed with polycythemia vera. Scientists have linked the disease to benzene, a contaminant of concern at McAdoo Associates, and radiation, which is emitted from NEPCO and the county's five other waste-coal-fired power plants. The Still Creek area also lies about 85 miles northeast (that is, downwind) of the Three Mile Island nuclear plant, which suffered a partial meltdown in 1979, and 29 miles southeast of Berwick's Susquehanna nuclear plant. Though radiation levels emitted by coal-burning and normally operating nuclear plants are believed to be relatively low, every exposure -- no matter how small -- increases cancer risk, according to the National Academy of Sciences' latest evaluation.

To put the seven Still Creek polycythemia cases in perspective, consider that worldwide incidence rates of the disease range from 5 to 26 cases per 1 million people, according to the Leukemia and Lymphoma Society. Yet only about 4,000 people live in all of Rush Township, where Still Creek is but one neighborhood.

I first heard about the Coaldale meeting earlier this week in communications with ATSDR regional representative Lora Werner. I asked her to send me more information about it and received a copy of the following e-mail summary of the event, written by Barbara Allerton of PADOH:

From: "Allerton, Barbara" [ballerton@state.pa.us]
Sent: 08/17/2006 03:21 PM
To: White, Mark (EPI)" ; Bogdan, Gregory" ; Weinberg, Gene" ; Lora Werner; lxw2@cdc.gov; loretta.bush@cdc.hhs.gov; Otto, Robin"
Cc: Axp9@cdc.gov; spc0@cdc.gov; Logue, James"
Subject: Summary of Coaldale/Miners' Memorial Hospital Grand Rounds held on 8/16/06

On August 16th, Dr. Greg Bogdan (Community Epidemiology Division, Bureau of Epidemiology), Lora Werner of the Agency for Toxic Substance and Disease Registry (ATSDR), and Ms. Barbara Allerton (Health Assessment Program, EHE Division, Bureau of Epidemiology), presented information and materials to eight (8) physicians and their support staff at a Grand Rounds program for staff physicians at Coaldale/Miners’ Memorial Hospital. The program was in response to community and medical professional concerns about the rates of illnesses in the Tamaqua area, particularly cancer rates and the incidence of p. vera. Information was presented on local drinking water quality, cancer incidence (particularly p. vera), and reporting p. vera to the Pennsylvania Cancer Registry. The physicians were very interested in the information provided and extra time was given to the discussion in order to answer all their questions. Representatives from the offices of U. S. Senator Arlen Specter and Pennsylvania Representative Dave Argall attended the meeting and the senator's aide expressed an interest in expanding the evaluation of the p.vera in this community. To date, the Health Assessment Program and ATSDR have conducted or planned the following activities to address the community concerns:

* The Bureau of Epidemiology prepared a Cancer Incidence Review of a three county area in December 2005.

* ATSDR prepared a Record of Activity evaluating residential and public water quality in the Tamaqua area.

* The Health Assessment Program and ATSDR prepared and distributed a June 2006 Health Professional Update on Tamaqua Area Environmental Community Health Concerns which included summaries of the review of available residential and public water quality sampling data as well as the December 2005 Cancer Incidence Review. This fact sheet was distributed to twelve (12) family practice physician groups serving Tamaqua area residents to communicate the public health response to community concerns and, in part, to correct accusations that the public water source is contaminated from the former McAdoo Associates Superfund site.

* Prepared and distributed an August 2006 Health Professional Update on Tamaqua Area Environmental Community Health Concerns which includes information on how to report p. vera as well as to define what constitutes a case of malignant p. vera. This information was prepared in order to ensure that Pennsylvania Cancer Registry is capturing all cases of p. vera as well as to better define those cases reported to date. Local environmental groups have conducted door-to-door self-reported disease prevalence surveys in Tamaqua area communities and allege that p. vera is underreported in the Tamaqua area.

* Additional grand rounds presentations are scheduled or offered to the following hospitals serving Tamaqua area residents: Good Samaritan Hospital (9.21.06) and Pottsville Hospital in Pottsville and the Lehigh Valley Hospital in Allentown

* Informational packets were or will be distributed to Tamaqua area physicians at the grand round presentations, by appointment, or via U.S. Mail.

* ATSDR and the Health Assessment Program provided comments on a Community Fact Sheet to be distributed by the U.S. EPA Region 3 Office.

Lora/Greg: Please feel free to add to or provide any additional comments on the meeting.

Thank you,
Barbara

As I often do when I get documents from public agencies, I forwarded a copy to Picciano and other local sources for comment. They were livid. Picciano sent the following e-mail to Werner:

From: Dante Picciano
To: Lora Werner
Cc: David Argall
Sent: Thursday, August 17, 2006 7:37 PM
Subject: Summary of Coaldale/Miners' Memorial Hospital Grand Rounds held on 8/16/06

I would like comment on the e-mail [from Allerton]. I realize that you were not the author of the e-mail but I want to make you aware of my concerns. First, the e-mail states:

"This fact sheet was distributed to twelve (12) family practice physician groups serving Tamaqua area residents to communicate the public health response to community concerns and, in part, to correct accusations that the public water source is contaminated from the former McAdoo Associates Superfund site."

The highlighted part of the sentence is a conclusion based on the absence of fact. On March 20, 2006, our petition to the ATSDR contained the following:

"8. The results of the chemical analysis of the water in the Still Creek Reservoir showed 76 parts per billion (ppb) of lead and 56 ppb of zinc (see Attachment 2).

9. The 76 ppb of lead in the reservoir is more than 5 times the allowed drinking water Maximum Contaminant Level of 15 ppb for lead.

10. The results of the chemical analysis of three soil sediment samples showed:

a. 1.36 to 1.94 parts per million (ppm) of beryllium,

b. 2.24 to 3.26 ppm of cadmium,

c. 63.1 to 93.5 ppm of lead,

d. 17.8 to 28.8 ppm of nickel,

e. 282 to 414 ppm of zinc, and

f. 200 ppb of methylethylketone (see Attachments 3, 4 and 5).

11. The results of the chemical analysis of a catfish caught in the reservoir showed 7.34 ppm of zinc (see Attachment 6)."

I do not know whether there is a contamination problem at the Still Creek Reservoir but I do know that there is evidence of a problem.

The e-mail also states:

"Local environmental groups have conducted door-to-door self-reported disease prevalence surveys in Tamaqua area communities and allege that p. vera is underreported in the Tamaqua area."

Again, I have trouble with the highlighted part of the sentence. As you know, on August 4, 2006, I informed you of two additional cases of polycythemia vera along the Ben Titus Road. This brings the total to at least six cases in this area.

In the future, I would hope that "investigators" provide data in support of their conclusions (allegations and accusations).

After sending that e-mail, Picciano learned of a seventh case of polycythemia vera along Ben Titus Road and passed the information along to Werner, noting that "these victims may be 'alleged' to you but they are real to me." Werner defended the term, saying PADOH used it in the e-mail summary because "as health authorities we can't consider these verbal or news reports of cases validated ... until we get this information from the physicians."

Picciano was not assuaged. He blasted the government agencies for their response to the area's health problems.

"This memo provides evidence of a cover-up in the making," he said. "The government's position seems to be that if they ignore the problem long enough, it will go away. I wonder if the victims afflicted with polycythemia vera feel better knowing that local environmental groups allege that polycythemia vera is underreported in the Tamaqua area and that the ATSDR and the PA DOH will be correcting accusations that the public water source is contaminated from the former McAdoo Associates Superfund site."

Added Picciano, "The ATSDR and the PA DOH have decided, in the absence of any evidence, that there are no health problems associated with the McAdoo Superfund site and now they are going to collect evidence to support their decision."