By Anthony DePalma
The New York Times
September 6, 2006
The largest health study yet of the thousands of workers who labored at ground zero shows that the impact of the rescue and recovery effort on their health has been more widespread and persistent than previously thought, and is likely to linger far into the future.
The study, released yesterday by doctors at Mount Sinai Medical Center, is expected to erase any lingering doubts about the connection between dust from the trade center and numerous diseases that the workers have reported suffering. It is also expected to increase pressure on the federal government to provide health care for sick workers who do not have health insurance.
Roughly 70 percent of nearly 10,000 workers tested at Mount Sinai from 2002 to 2004 reported that they had new or substantially worsened respiratory problems while or after working at ground zero.
The rate is similar to that found among a smaller sample of 1,100 such workers released by Mount Sinai in 2004, but the scale of the current study gives it far more weight; it also indicates significant problems not reflected in the original study.
For example, one-third of the patients in the new study showed diminished lung capacity in tests designed to measure the amount of air a person can exhale. Among nonsmokers, 28 percent were found to have some breathing impairment, more than double the rate for nonsmokers in the general population.
The study is among the first to show that many of the respiratory ailments – like sinusitis and asthma, and gastrointestinal problems related to them – initially reported by ground zero workers persisted or grew worse in the years after 9/11.
Most of the ground zero workers in the study who reported trouble breathing while working there were still having those problems up to two and a half years later, an indication that the illnesses are becoming chronic and are not likely to improve over time. Some of them worked without face masks, or with flimsy ones. “There should no longer be any doubt about the health effects of the World Trade Center disaster,” said Dr. Robin Herbert, co-director of Mount Sinai’s World Trade Center Worker and Volunteer Medical Screening Program. “Our patients are sick, and they will need ongoing care for the rest of their lives.”
Dr. Herbert called the findings, which will be published tomorrow in Environmental Health Perspectives, the journal of the National Institute of Environmental Health Sciences, “very worrisome,” especially because 40 percent of those who went to Mount Sinai for medical screening did not have health insurance, and will thus not get proper medical care. The Mount Sinai results found, as studies done by the New York City Fire Department also have, that those who showed up in the first hours and days after the twin towers collapsed have the worst medical problems. Seventy percent of the workers in the study arrived at the site between Sept. 11 and Sept. 13.
Mount Sinai’s screening and monitoring program, which excludes New York firefighters, who are tested in a separate program, run by the New York Fire Department, covers law enforcement officers, transit workers, telecommunications workers, volunteers and others who worked at ground zero and at the Fresh Kills landfill, where debris was taken.
Members of the New York Congressional delegation, who have been fighting to get the federal government to recognize the scope of the health problem created by toxic materials at ground zero, saw the Mount Sinai study as proof that the federal government has been too slow to address the issue.
Senator Hillary Rodham Clinton, who participated in the news conference at Mount Sinai yesterday morning, along with Representatives Jerrold Nadler and Carolyn B. Maloney, said that the results made the need for federal assistance for treatment more critical than ever.
“This study, I hope, puts to rest any doubt about what is happening to those who were exposed,” said Mrs. Clinton, who was among those who pushed for $52 million in federal funding for health treatment for the ground zero workers, the first treatment money provided by the Bush administration. “This report underscores the need for continued long-term monitoring and treatment options – they go hand in hand,” she said.
Several members of the delegation are scheduled to meet in Washington tomorrow morning with Michael O. Levitt, the secretary of the Department of Health and Human Services, to press for more aid.
Mayor Michael R. Bloomberg, speaking at a news conference at City Hall yesterday, questioned the conclusiveness of the study, saying that statistics could suggest a connection between events, but not prove a direct link.
“I don’t believe that you can say specifically a particular problem came from this particular event,” he said. Nonetheless, Mr. Bloomberg announced that the city would create a screening and treatment program for anyone exposed to the trade center dust or fumes.
The Mount Sinai study, released yesterday, which covers 9,442 workers who met the screening program’s eligibility criteria and agreed to have their health data included, focused on respiratory problems because doctors believe those illnesses are the first to surface. Of those studied, 46.5 percent reported symptoms like chest tightness, shortness of breath and dry cough that generally affect the lower airways of the lungs.
And 62.5 percent reported upper-respiratory symptoms like sinusitis and nose and throat irritations. (The study did not include cases of cancer reported by workers and their relatives.)
The doctors said that the persistent nature of the respiratory symptoms raised troubling questions about the workers’ long-term health. Dr. Philip J. Landrigan, a founder of the screening program at Mount Sinai and an author of the new study, said that the toxic nature of the trade center dust had led doctors to conclude that there would be serious health issues for years to come, especially for workers who were exposed to the heaviest concentrations in the early days after the terrorist attack.
“This was extremely toxic dust,” Dr. Landrigan said, noting that some samples showed the dust to be as caustic as drain cleaner. The dust also contained innumerable tiny shards of glass, which could get lodged in the lungs, and a stew of toxic and carcinogenic substances, like asbestos and dioxin, that could potentially lead to cancer decades from now.
With the expanding dimensions of 9/11 health problems, concern is also growing about the cost of health care for responders, particularly the 40 percent who either never had health insurance or who lost employer-provided coverage after they became too sick to work.
Dr. Landrigan declined to estimate what the total cost might be, saying only “it will be very expensive.”
Dr. John Howard, who was named the federal 9/11 health coordinator in February, has already said that the $52 million the federal government has appropriated for treatment late last year is inadequate. He said in an interview yesterday that the new study will very likely mean that the gap between funds and the need for them is going to grow.
But he said the solid medical data from Mount Sinai would help him make the case that more needs to be done. He said that there was little doubt that if a third of the people in the study showed abnormal breathing, similar problems exist among the entire population of 40,000 rescue and recovery workers.
“These are just the kind of facts that are important in making a logical argument that the funding needs to be adjusted,” said Dr. Howard, who is also the director of the National Institute for Occupational Safety and Health.
Mount Sinai officials said they would release a study of mental health effects on ground zero workers soon. They also are planning to begin a statistical program this fall to examine the occurrence of cancer, lung diseases and other ailments among that group. That information will then be compared to national rates to see if there is a higher-than-expected incidence of those diseases.
Diane Cardwell contributed reporting for this article.
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