A Scientific Study Brings out the Skeptics and, Please, Do Overwhelm Us with the Data! A few weeks ago I wrote about a cluster of Superfund sites and waste coal power plants in and around Schuylkill County, PA, where there are also unusually high rates of cancer. Coincidence or cause and effect? The Agency for Toxic Substances and Disease Registry (ATSDR) had just wrapped up a year-long study to determine if a connection exists between the cancer, focusing only on the disease polycythemia vera (PV), and the environment. A public meeting had been planned to announce the results and then it was abruptly called off. But, on October 17 the ATSDR offered a new date for the meeting and this time it took place as scheduled on Wednesday, October 24. The ATSDR's lead investigator is still relocated in Mozambique, however other agency representatives were in attendance to present and explain the results, although no hard copy of the report was available. The ATSDR is charged under the Superfund Act to assess the presence and nature of health hazards at Superfund sites, to help prevent or reduce further exposure and resulting illnesses, and to expand knowledge of the health effects from exposure to hazardous substances. The ATSDR press release for the Schuylkill County study claims that "The Agency for Toxic Substances and Disease Registry (ATSDR) confirmed 38 cases of polycythemia vera (PV) in Schuylkill, Luzerne, and Carbon counties. ATSDR found no link between environmental factors and PV in this area. PV is a rare blood disorder characterized by the overproduction of red blood cells. It is classified as a cancer because stem cells in the bone marrow do not respond to the normal signals to stop reproducing red blood cells." Even though the ATSDR did not find a link between the environment and PV in their year long study does not, of course, mean that one does not exist. Yet, Senator Arlene Specter (R-PA) made this leap by writing on October 22nd that he was "heartened by the study's findings that there are no environmental or occupational causes for the disease; however, the fact remains that there is a higher than usual number of cases for this community." Dr. Peter Baddick, an internist with a practice in Franklin Township, has seen firsthand the elevated cancer rates in his patients for decades now. He described the ATSDR meeting as "just a lot of smoke and mirrors." He questioned the decision to study PV and PV alone. He believes the ATSDR should include two entire groups of diseases called myelodysplastic and myeloproliferative, because people are affected differently by similar toxic exposure. "This is not a study but rather a half-baked survey or questionnaire," he told me. "No environmental causes were found because they were not truly looking for one." Another local in attendance was Dr. Dante Picciano. He is both a geneticist and lawyer and has been combating the dumping of toxic wastes in the area since 2004. He was similarly outraged by the meeting. In an email to Sue Sturgis, he responded to the prepared statements of ATSDR and Specter. "Both statements are bullshit. The cause is either genetic or environmental. There are no other choices. The scientific community acknowledges that polycycthemia vera is not a genetic disorder. Therefore, the disease must be caused by environmental factors." The day after the meeting he had this to say: "The meeting was such a failure that I felt compelled to write and let everyone know what really happened. First, here is some background. In June 2004, the Carbon County Groundwater Guardians uncovered an unusual cluster of patients with polycythemia vera living on Ben Titus Road along the Still Creek Reservoir in Rush Township. Polycythemia vera (PV) is a rare bone marrow cancer occurring with a frequency of between one in 100,000 and one in 200,000 people per year. The Carbon County Groundwater Guardians initially uncovered three and possibly four patients, including two in one household, among approximately one hundred or so people living in the area. It was obvious to us that there was a significant increase in the incidence of PV in this area. We then wanted to know what was the cause of this increase. More than three years and three studies by government scientists later, we are no closer to identifying the cause of the problem. In fact, it took the government scientists more than three years to confirm that there was a significant increase in the incidence of PV in the area! At the meeting, the ATSDR circulated a news release that stated, "ATSDR found no link between environmental factors and PV in this area." Technically, this statement is correct. However, it must be pointed out that the ATSDR scientists didn't look very hard for environmental factors. The ATSDR news release indicated that participants were only questioned about "their residence, employment, and lifestyle." Is there any wonder why the ATSDR was unable to find a link between environmental factors and PV in this area? In a similar bit of tomfoolery, Senator Arlen Specter stated in a letter to the Director of the ATSDR and to the Secretary of the PADOH, "I am heartened by the study's findings that there are no environmental or occupational causes for the disease." Apparently, Senator Specter believes that the government scientists have proven a negative! The truth of the matter is that there are only two possible causes for the PV. It is either genetic or environmental. The scientific and medical communities acknowledge that PV is not an inherited disease. In other words, PV is not a genetic disorder. On the other hand, there is evidence that environmental factors cause or contribute to PV. A peer reviewed scientific article indicates that an excess risk of PV has been suggested in embalmers and funeral directors, as well as in persons exposed to benzene, petroleum refineries, and low doses of radiation (A. Tefferi, "Polycythemia Vera: A Comprehensive Review and Clinical Recommendations," Mayo Clin. Proc. 78:174-194, 2003.) The government scientists did not appear to have been aware of this article. I would also like to point out that the ATSDR and the PADOH failed to provide the public with a hard copy of their report. When questioned about the hard copy, the government officials indicated that one had not been prepared. That is right, they don't have a written copy of their report but they felt comfortable explaining their results to the public. In addition, a government scientist said the agency did not wish to overwhelm residents with data. Let us see the data. Let us know the possible basis for the government's conclusions. Without access to the data, it is difficult to thoroughly critique the government's allegations."

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