by Mike Magner
7
THE STRUGGLE FOR DATA
You and I both know how this would “play in Peoria.”
—KATHY SKIPPER, AGENCY FOR TOXIC SUBSTANCES AND DISEASE REGISTRY, OFFICE OF POLICY AND EXTERNAL AFFAIRS
If the Marine Corps had been cooperative with regulators on cleanup plans at Camp Lejeune, the same could not be said for its efforts to find out who might have been harmed by the pollution.
Once the base was placed on the Superfund list, a required federal health study kicked in to determine if people had been exposed to unsafe levels of contamination. The task of conducting this Public Health Assessment fell to the Agency for Toxic Substances and Disease Registry, or ATSDR, created by Congress in the CERCLA law that established the Superfund program in 1980. Not intended as a regulatory agency, the ATSDR had a relatively small budget (less than $16 million for health assessments nationwide in 1990).1 It had to rely largely on the polluters themselves for funding and data in order to study whether their pollution affected public health, hardly the ideal way to conduct scientific research. The science of defining chemical pathways, determining levels of human exposure, and taking into account other environmental influences is anything but exact, yet to have impact on policy it must stand up to rigorous standards and extensive peer review.
In the case of Camp Lejeune, there was an additional conflict. The ATSDR is assisted on many studies by a sister agency within the Department of Health and Human Services (HHS), the Public Health Service, which has its roots in the US Navy. Many in the so-called “commissioned corps” consider themselves part of the military, and even wear Navy uniforms and have similar ranks, operating under the command of the surgeon general of the United States. Thus, not only were the government scientists who were assigned to find out if the US Marine Corps had inadvertently poisoned people at one of its largest installations dependent on the military for the money and information needed to do the job, but they were at least loosely connected to the military themselves. It was kind of like the nerdy little brother being told to find out if the bullying star athlete in the family had been violating any of Mom and Dad’s rules.
Though it was only twelve years old when it began studying Camp Lejeune’s contamination issues in 1992, the ATSDR already had a questionable reputation. A joint study released by two environmental groups that year maintained that both the CDC and the ATSDR—two federal agencies most responsible for protecting Americans from harmful pollution—routinely produced health studies that were “inconclusive by design” because they used weak testing methods, inappropriate statistical analyses, biased contractors, and misguided assumptions about the kinds of health problems that might have occurred. The result was that very few of the ATSDR’s assessments showed harmful exposures to toxic pollution.
ATSDR investigators also were known to avoid direct contact with people in affected communities, the study found. “According to both local citizens and their physicians, ATSDR has lacked even the simple etiquette of returning their phone calls,” the report said. “Agency officials have themselves acknowledged that ‘Unless you are a senator or a senator’s staff we won’t respond.’” Environmentalists reached a damning conclusion about the CDC and the ATSDR. The Environmental Health Network and National Toxics Campaign Fund concluded: “They have become virtual propaganda tools of polluting industries—making public reassurance instead of public protection their foremost focus. One result has been an increase in public complacency and government inaction at many sites where further precautions to reduce toxic exposures are merited.”2
To its credit, the ATSDR quickly determined there was reason to be concerned about people in Tarawa Terrace who had used water from wells contaminated with perchloroethylene, or PCE, that had been dumped by ABC One-Hour Cleaners across the highway from the base housing. A Public Health Assessment completed in 1990 on the dry-cleaners’ pollution prompted the agency to start looking for health effects, especially on babies, in the Tarawa Terrace population. They began by compiling birth records from the base hospital going back more than twenty years.3
The ATSDR took much longer to zero in on potential exposures from the many sites on the base where land or groundwater was tainted by hazardous materials used in operations. A major reason for that delay was a lack of cooperation from the Marine Corps in providing information about base contamination. Nearly two years into the study, on February 23, 1993, the epidemiologist in charge of the Public Health Assessment at Camp Lejeune, Nancy Sonnenfeld, wrote the base’s communications director, Neal Paul, saying she had received only one set of pre-1985 data on drinking water at the base. Even that data was flawed, showing some contaminants at levels so low it would not have been possible to detect them using available technology. Sonnenfeld tried to be reassuring about what the health agency might find if it had more information: “As the Navy has noted, the discovery of contamination in potable wells at these sites does not in itself imply that anyone actually drank or washed with contaminated water; the water was treated and diluted before distribution,” she wrote. “Therefore, I would like to examine the data from samples of the tap water which was actually distributed to individual residences and housing areas on the base.”
Sonnenfeld asked for information about Camp Lejeune’s water treatment processes, about when tap water was analyzed, about the dates when contamination was first discovered in potable wells and in tap water, and about the frequency of sampling before and after the closures of contaminated wells. She added that she was also still in need of information about all the base housing areas, how many people lived in each, and which water systems they used. And she asked for rough estimates of the numbers of people who had been living at the base for longer than five years and those who had been there for more than ten years at the time the contamination was discovered.4
A couple of weeks later, on March 5, 1993, ATSDR environmental engineer Stephen Aoyama followed up with a letter to Paul asking for information about cleanup work that had been done so far at the base, along with documents from the Superfund program, such as site studies and work plans, and a full index of the administrative record for the cleanup effort. But the Marine Corps continued to stonewall for another year and a half, prompting the ATSDR’s Carol Aloisio, in the office of the assistant administrator, to send a letter higher up in the Navy command. “As you are aware, we have had much difficulty getting the needed documents from MCB Camp Lejeune,” Aloisio wrote on September 2, 1994, to Yvonne P. Walker at the Navy Environmental Health Center in Norfolk, Virginia. “We have sent MCB Camp Lejeune several requests for information and, in most cases, the responses were inadequate and no supporting documentation was forwarded. . . . For an ATSDR public health assessment to be useful, it is important that all pertinent information be provided for evaluation.”5
The commanding officer of the Navy Environmental Health Center, W. P. Thomas, responded eleven days later by sending a letter to the commander of the Naval Facilities Engineering Command suggesting that Camp Lejeune’s environmental managers cooperate with the ATSDR—but not ordering them to do so. “In general, we recommend that the Department of the Navy installations routinely provide ATSDR with documents distributed to the installation’s Restoration Advisory Board,” Thomas wrote. Base officials should keep the ATSDR updated with revisions to the administrative index for the Superfund cleanup and “should respond to requests for information promptly with appropriate supporting documents.”6
Despite the limited cooperation, the ATSDR managed to complete a first draft of the Public Health Assessment for Camp Lejeune in September 1994. The authors of the assessment concluded that there were “probable health effects” from exposures to volatile organic compounds in the drinking water and recommended further study of babies born to women who drank the contaminated water during their pregnancies. “A study of birth outcomes, in particular of low birth-weight, pre-term births and fetal deaths, should further our understanding of the health effects of low-dose VOC exposu
re,” the draft assessment said.
Navy officials threw a fit. Andrea Lunsford, head of the health risk assessment department at the Navy Environmental Health Center in Virginia, responded to the ATSDR’s initial public health assessment with a “medical review” dated October 28, 1994. Lunsford challenged the health agency’s assumption that a study of birth outcomes would add to understanding about the effects of low-dose VOC exposure, saying it was difficult to determine “causal relationships” between specific contaminants and certain health effects, and even more difficult when the subjects of the proposed study were part of a “a transient, military population” exposed to many other harmful substances as well. Lunsford also said it was “somewhat misleading” to suggest that there were “probable health effects for VOC exposures” at the base, “since the risk estimates are based on personnel being exposed to these maximum detected values for a period of one year.” In reality, people were exposed to varying levels of contamination throughout their time on the base, not always to the maximum levels, she said.7
There were other criticisms, including a complaint about the ATSDR saying that personnel involved in training exercises could be exposed to harmful contaminants without being specific about what areas of the base and what chemicals posed that threat. Of course, if the Marine Corps had provided full information about contaminated sites, the health agency could have given more precise assessments. ATSDR’s scientists pressed on, and despite another delay when “the agency’s entire file on Camp Lejeune was mistakenly thrown out—tossed in the trash—by a contractor,” as a House investigation found in 2010, a final version of the Public Health Assessment was released to the public in August 1997.8
The report said there were ten sites out of ninety-four potential areas of contamination on the base that had potential for human exposure. And it found three past health hazards: volatile organic compounds in three drinking-water systems (Tarawa Terrace, Hadnot Point, and Holcomb Boulevard), lead in tap water in buildings with lead plumbing, and exposure to pesticides in soils at the former day-care center. On the drinking-water exposures, the agency said solvents including TCE and PCE “have been documented over a period of 34 months, but likely occurred for a longer period of time, perhaps as long as thirty years.”
The biggest concern to the scientists was the fetal exposures. The agency said it had already begun investigating “pregnancy outcomes” at the base and had identified about 6,000 infants whose mothers lived in housing with contaminated water supplies. It had found a “statistically significant” decrease in birth weights for males in that group, particularly among babies born to mothers who lived in areas served by the Hadnot Point water system, but also among babies whose mothers lived at Tarawa Terrace. Low birth weights, generally below five and a half pounds, are warning signs of other potential health problems.9
Surprisingly, the ATSDR did not express concern about the poisoned aquifer at Camp Lejeune. “Groundwater contamination on base is considered no apparent public health hazard because several programs are in place to detect, monitor, and predict groundwater contamination flow before people could be exposed to any contaminated drinking water,” the agency said. That finding seemed to conflict with a number of previous reports about the base aquifer, such as the 1988 confirmation study for the Navy by Environmental Science and Engineering, Inc., that described “extremely elevated” levels of benzene in water supply wells at Hadnot Point. And it seemed as if the agency was unaware of the large pools of fuel that that were floating on top of the shallow aquifer, fed by leaks from underground storage tanks and pipes at the rate of 1,500 gallons a month.
Nevertheless, the release of the report—with the startling news that federal health scientists had evidence that babies born at Camp Lejeune might have been harmed by contaminated drinking water—generated some newspaper stories and TV coverage in eastern North Carolina. On September 2, 1997, about a month after the report became public, the manager of the environmental restoration program at the base, Kelly Dreyer, distributed a memo saying that to date, “two individuals have contacted Camp Lejeune regarding abnormalities in their children.” One was a woman who lived at the base in the early 1980s and had two children born with birth defects, Dreyer said. The other was Jerry Ensminger, whose daughter Janey had been conceived at Camp Lejeune in 1976 and died of leukemia in 1985.10
Ensminger, it turned out, had been sitting down to dinner in front of his TV one evening in August 1997 when he caught a report about the ATSDR study on a local North Carolina station. When he heard that children at Camp Lejeune had been exposed to cancer-causing chemicals in the water, Ensminger dropped his plate of spaghetti on the floor and stood in stunned silence. The former drill instructor, now retired from the Marine Corps after twenty-five years of service, had agonized for twelve years about his daughter’s inexplicable death, and at last there was a possible explanation. “It was like God saying to me, here is a glimmer of hope that you will find your answer,” Ensminger said.
Unknown to Ensminger at the time, the Defense Department was doing everything it could to avoid finding out how its pollution might have affected babies and children. It pushed hard against the ATSDR’s proposal to study the health of infants born at Camp Lejeune, arguing that a lengthy and expensive investigation would still be inconclusive no matter what was found.
The director of federal programs for the ATSDR, Mark Bashor, tried to make a case for the study at the highest levels of the Pentagon. On July 16, 1997, he wrote to Elsie Munsell, deputy assistant secretary of the Navy for environment and safety, expressing concerns about the Defense Department’s resistance to investigating possible childhood cancers linked to solvents in the water at Camp Lejeune. “It appears that some of this reluctance may be attributable to a lack of understanding regarding the need and requirement for the study,” Bashor wrote.11
“ATSDR’s investigation indicates that more than 6,000 children were probably exposed to TCE and PCE in utero between 1968 and 1985 in base housing at Camp Lejeune,” Bashor explained. He went on:
Based on an epidemiologic study recently completed by the Massachusetts Department of Public Health in the town of Woburn, Massachusetts, there is evidence indicating that these children exposed to TCE and PCE may be at increased risk of adverse health effects. The Woburn study observed an association between the mother’s potential for exposure to TCE and PCE in drinking water and childhood leukemia, particularly when exposure occurred during pregnancy. To our knowledge, no other study has explicitly examined the potential association between the environmental contaminants and childhood leukemia. Although the solvent mixture was slightly different at Woburn than at Camp Lejeune, the levels of solvents found in the drinking water at Camp Lejeune were comparable to, or higher than, the solvents found in wells at Woburn.
Bashor acknowledged that no single study could prove a connection between maternal exposure to the solvents and diseases in the women’s offspring, but because of the findings in Woburn, he wrote, “we feel that there is a substantial possibility that the children exposed to solvents in utero at Camp Lejeune are at increased risk of childhood cancer.”
A full description of the study proposal attached to Bashor’s letter described childhood leukemia as a disease in which white blood cells accumulate but fail to reach functional maturity, leaving the victim susceptible to infection, hemorrhage, and “inadequate cellular nutrition.” At the time, the proposal said, there was an annual rate of 7.1 cases per 100,000 children under age four, and the disease was fatal within five years for about a third of the children diagnosed with leukemia before age ten and for half of all victims of the disease diagnosed after age ten.
There had been studies done up to that point linking leukemia to solvents, but most of those involved occupational exposures. Only three studies—all conducted at Woburn—focused on leukemia in children, and the last found “a very strong association” between TCE exposure in the womb and childhood leukemia. At Camp Lejeune, there were abou
t 6,000 babies exposed to the solvent during gestation and about 6,000 others born to mothers who lived in areas not affected by the contamination. “This existing database presents a unique opportunity to examine this potential association in a cohort of moderate size where exposure is relatively well-defined,” the study proposal stated.
The ATSDR’s Jeanetta Churchill also sought support for the study from the White House through the Office of Management and Budget. Leukemia, her report said, was the most common cancer occurring in childhood and was of “tremendous public health concern.” The studies in Woburn had shown an eightfold increase in risk among offspring of women exposed to TCE in water during pregnancy, it said.
“Epidemiology is not an exact science that easily lends itself to proving a definite cause-effect relationship between an exposure and outcome,” Churchill’s appeal to the OMB said. “Before the scientific community can accept the hypothesis that maternal exposure to VOCs causes childhood leukemia or birth defects, the cause-effect relationship must be seen consistently among studies. Therefore, this proposed project has the potential to greatly contribute to the body of scientific knowledge by possibly showing a consistent association between the exposure and outcome.”12
The ATSDR’s plan was to first locate as many of the children born to residents of the base between 1968 and 1985 as possible. The parents who were contacted would be asked in an interview about health problems to identify those children with cancer or birth defects. Any cases reported would then need to be verified through medical records. But the health agency faced a real challenge—the database of births at Camp Lejeune did not include Social Security numbers for either the children or their parents. So the ATSDR decided it would try to have the families come to them “by widely advertising our desire to locate individuals who were born, or whose children were born, at the USMC Camp Lejeune between 1968 and 1985 in publications targeting military personnel.” If the agency did not hear from 80 percent of the 12,000 families with children born at the base hospital during those seventeen years, it would try to track enough others to reach that percentage of respondents, with help from the Navy and possibly credit-rating agencies like Equifax, the proposal said.13
