doctors, which side are you on?
July 6, 2014
About all that’s left between us and fracking is a state-commissioned health study that’s big on dangers and disruptions, gaps and shortcomings, but nevertheless seems willing to list some recommendations and hope for the best.
That’s not enough.
Public health scientists at the Maryland Institute for Applied Environmental Health (MIAEH) recently unveiled their final progress report during a meeting at Garrett College. They explained some of the health burdens Garrett and Allegany county residents would have to bear if the state permits fracking in the Marcellus Shale that lies deep under their land.
The infant mortality rate, for example, in those counties is already higher than in the rest of the state. “With additional industrial activity … you could see an impact on infant mortalities,” Dr. Sacoby Wilson said. Translation: More babies could die. Garrett and Allegany also have a higher percentage than the rest of the state of elderly, who would be particularly vulnerable to increased air pollution. Children, pound for pound, breathe more air than adults, putting them at greater risk as well. Rates of some cancers are already higher in these counties than the rest of the state. “We could see an increase in cancer from exposure to pollutants,” Dr. Wilson said.
Much, however, remains unknowable, the public health researchers said. Dr. Donald Milton said that research on the effects of fracking is new, less than 10 years old, and extremely limited. And much was beyond the scope of the report and data available, including a cumulative risk assessment. If Maryland allows fracking, it “will be in a unique position to collect some of these things,” he said.
The question, then, is whether Western Marylanders have consented to be test cases for this data collection.
Unless changes are made in the final report, the state seems ready to continue the experiment on people and communities witnessed in Pennsylvania, West Virginia, Ohio, Texas and Colorado, with predicable results.
Deciding whether Maryland should allow drilling is not part of the health report. Once completed in the next week or so, the health report will be used by the state’s Marcellus Shale advisory commission and state Departments of the Environment (MDE) and Natural Resources (DNR) to help determine whether fracking can be done “without unacceptable risks of adverse impacts to public health, safety, the environment and natural resources,” according to Gov. Martin O’Malley’s executive order.
So, instead of saying yes, no or wait for more research, the Maryland scientists created a scorecard of sorts for public health hazards. The higher the score, the greater the harm.First, they collected baseline public health information for the two western counties and reviewed scientific literature and other reports on fracking and health. They also monitored noise near compressor stations and in homes in one county in West Virginia. With that science as the backdrop, Dr. Amir Sapkota explained, each selected impact “earned” points, based on whether the hazard affected vulnerable populations, how long the exposure was likely to last, the frequency of exposure, the likelihood of health effects, the severity of the health effects, whether the hazard was communitywide or localized, and whether setbacks would lessen the harm. Impacts with the highest score, 15 to 17 points, would have the most ill effects on public health. They were color-coded red. Stop. Other items were in the medium hazard range (yellow) and some, with scores of 6 to 9 points, would carry no or a low health hazard (green).
For example, one hazard the group evaluated was the potential for poor air quality and exposure to volatile organic compounds, or VOCs. The researchers found elevated levels of VOCs near frack operations in West Virginia; and they had looked at studies that show harms from exposure to such VOCs as benzene, butadiene, formaldehyde, and one showing an association between proximity to frack wells and congenital heart defects and neural tube defects in babies. (That Colorado study is here. In addition, a 2013 working paper by a Cornell researcher in Pennsylvania found low birth weights and APGAR scores in babies born to mothers within 2.5 kilometers of frack sites, and Princeton and Columbia University researchers, in a study presented in January at the American Economic Association, again found that proximity to a fracking site increased the risk for low birth weights and APGAR scores. )
Based on the resulting score, the group concluded there was “high likelihood” that changes in air quality from fracking would be a hazard to public health. Red. Stop.
For several hazards, such as soil contamination or effects on food, the study group lacked enough information to devise a score. (Although research published in the journal of Environmental Science & Technology is ominous). In addition, studies that link exposure to illness require three to five years for a study and another couple years to publish the results, Dr. Sapkota said. He also noted the “gap in time — between when exposure happens and when you get sick — of months, years, even decades.” Therefore, “absence of investigation [or] absence of data is not equal to absence of harm,” Dr. Sapkota said. At that, applause went up from the audience of about 50 in the college auditorium.
On the scorecard, the risk of earthquakes was low, because Maryland is not going to allow injection wells. Instead, the state would be content to send its toxic and radioactive waste to other states that haven’t caught on yet (although West Virginia seems about to catch on).
Also ranking high, or red, on the hazard scorecard were public safety and worker safety. With fracking, Dr. Sapkota said, come: truck traffic (1,000 roundtrips per well fracked; 6,000 roundtrips for a well pad with 6 wells); more accidents; delayed 911 response time; deteriorating road conditions; unsafe roads for pedestrians, drivers and children; more crime (for example, the report says, arrests rose 17 percent in heavily fracked areas of Pennsylvania and 32 percent in Battlement Mesa, Colo.), more cases of sexually transmitted diseases (up 32 percent in Pennsylvania and 217 percent in Battlement Mesa). Workers are at higher risk of developing lung cancer and silicosis from exposure to silica dust in frac sand. And increased use of medical services, by insured or uninsured workers, “would strain the existing healthcare infrastructure, likely leading to decreased quality, availability, and access to services,” the report said.
Oddly, the researchers ranked as medium the potential harm to water quality, even though a large percentage of the population relies on well water. Contributing to the score were one point each for “likelihood of health effects” and “magnitude/severity of effects.” A ‘1’ means “unlikely” and “little/no evidence that exposure is related to adverse health outcomes.” And yet an Associated Press report found hundreds of complaints about water contamination in at least four states. Pennsylvania has failed to inform residents when fracking polluted private wells. And risk analysts found that disposal of contaminated wastewater (from truck accidents, leaking casings, surface spills, fracturing fluids traveling through underground fractures; and disposal at treatment plants) poses a substantial potential risk of river and other water pollution. And a University of Missouri researcher found higher levels of endocrine-disrupting chemicals (linked to infertility, cancer and birth defects and other health problems) in surface and groundwater in Colorado.
Even a point more in those categories would have us in the red zone.
The scientists also cited Avner Vengosh’s Duke University study that found methane concentrations much higher in water wells within a kilometer of fracking operations and dismissed an industry-funded study that found otherwise. “We felt like that conclusion was not supported,” Dr. Sapkota said, “particularly given the large conflict of interest involved.” Dr. Milton noted at one point that methane — aside from its explosive qualities — wasn’t much of a health threat, but it often traveled with things that are, such as benzene and hydrogen sulfide. “We can’t write prescriptions of what should be monitored,” he said. “The community needs to develop it.”
Each harm builds on the others, creating a sum that scientists don’t yet understand. “It’s an emerging field, and we are still trying to figure it out … how to quantify cumulative risks,” Dr. Sapkota said. Because some people might benefit while others are harmed, disruption of social fabric, of community peace, is also a factor and adds to stress, he said. And yet, inexplicably, the cumulative effects ranked in the medium range. Presumably, how the points were assigned will be part of the full report.
the doctors’ prescriptions
The study group included a number of recommendations to lessen the harms, such as soil and air monitoring; 100 percent recycling of frack fluids; prohibition on using flowback water for road deicing or dust suppression; community panels to address noise and odor complaints; and an increase in state and local patrols to monitor truck traffic and to keep trucks off the road when school buses are transporting children. The researchers said proppants and engineered nanomaterials should be disclosed and trade secret chemicals “acknowledged.” They recommended that local governments train emergency and medical personnel and “consider health infrastructure as a high level priority when appropriating local government revenues derived from [shale gas development] and engage in long-term planning.” (The counties collect production taxes only after the gas is flowing through a pipeline, though, so the source of money for training in advance is a big question.) They also suggest engaging local communities “in monitoring and ensuring that setback distances are properly implemented.”
Dr. Sapkota said after the presentation that the recommendations can’t eliminate the hazards. Public safety will take a hit.
from the audience
Every speaker from the audience voiced grave concerns about gaps in the panel’s scope and in available research. Jim Guy from Oldtown in Allegany County criticized the “cavalier conversation” about “a lot of people getting sick. … My question is this: Who is going to be accountable for all this?”
Asked about the public health threat of climate change from leaking methane, Dr. Sapkota said that was a concern but outside the scope of the group’s review. (Two new reports have highlighted that risk, one by the National Oceanic and Atmospheric Administration and the other by Anthony Ingraffea at Cornell University.
The health care system faces huge burdens, said Rebecca Ruggles, director of the Maryland Environmental Health Network. “Nobody seems to be putting a price tag on that. … It’s the cost of doing business in this community, and then who is going to bear it?”
Dr. Clifford S. Mitchell, a commissioner on the state’s advisory panel and director of Maryland’s Environmental Health Bureau, said the study team lacked the time and resources to do an economic study. (The state’s economic study, done by Towson University’s Regional Economic Studies Institute, didn’t include health costs either.) Dr. Mitchell said he would work up some “back-of-the-envelope calculations” for the full report.
Robyn Gilden, an assistant professor at the University of Maryland School of Nursing, wanted to know what the medical community should be tracking in patients before and after fracking. Dr. Sapkota said low birth weight and “adverse” birth outcomes are easy to track, because the information is public and the time span — 9 months — is short. Dr. Milton and Dr. Mitchell said nosebleeds and skin rashes are frequent complaints that bear watching.
The presentation has many gaps, and major research is just emerging, said Gina Angiola, a retired physician and steering committee member of the Chesapeake Physicians for Social Responsibility. “What about asking for another three to five years?” she asked. More applause from the audience.
Mike Bagdes-Canning, who lives near fracking operations north of Pittsburgh, said he spends a good deal of time with people on the front lines of fracking. Wherever the gas industry goes, health problems follow, he says. Complaints that he commonly sees are flu-like symptoms, rashes, breathing problems, arsenic poisoning, headaches, shortness of breath, sleep disturbance, and mental health issues such as depression. “I come as your ambassador from Pennsylvania,” he said. “Don’t do what we’ve done.”
In introducing the scientists involved in the public health study, Dr. Mitchell boasted that Maryland is the only state studying the health effects of fracking before proceeding. Pennsylvania might prevent its health employees from discussing nosebleeds, rashes, cancer and other concerns from fracking with frantic residents calling for assistance. But that’s not Maryland, he suggested. “Part of the reason we have gone through this process is because Maryland is trying to distinguish itself … so we can learn from evidence about how not to do things.”
Far more protective would be a warning like Dr. Jerome Paulson’s to the Pennsylvania’s Department of Environmental Protection. Citing data on birth defects and low birth weights, water contamination and stress from noise, and the vulnerability of children, Dr. Paulson concluded, “Neither the industry, nor government agencies, nor other researchers have ever documented that [unconventional gas extraction] can be performed in a manner that minimizes risks to human health.” Or the stance of hundreds of doctors and other health experts in New York who have asked for a three- to five-year fracking moratorium.
–by elisabeth hoffman