by Dan Fagin
7. Dow, Ciba, and United Water have never revealed what percentage of the overall settlement each company paid, but Dow (as Union Carbide’s corporate successor) likely paid the largest share because the Parkway well contamination was so well documented.
8. Like the Toms River settlement, the Woburn settlement was supposed to be secret. Unlike in Toms River, however, its $8 million size was immediately leaked to the press. Each of the eight Woburn families ultimately received about $435,000, while the payouts to the sixty-nine Toms River families varied widely but probably averaged about $290,000 per family. In Toms River, families of children with leukemia received some of the largest settlements—in some cases, larger than what the Woburn families received—because the scientific evidence of environmental causation was stronger for leukemia than for other cancers. The Woburn lawsuit included only leukemia cases.
9. New Jersey Department of Health and Senior Services, Case-Control Study of Childhood Cancers in Dover Township, Volume I (January 2003), 18.
10. For the four nervous system cancer cases diagnosed before age five, the 9.00 odds ratio for high exposure to Ciba air emissions came close to achieving statistical significance because the lower bound of the 95 percent confidence interval was 0.86, just under 1.0. The upper bound was an extremely high 94.2.
11. For birth record study children diagnosed with cancer before age five, the odds ratio for high prenatal exposure to Ciba air emissions was 2.95, with a 95 percent confidence interval of 0.92 to 9.45.
12. Tom Feeney and Mark Mueller, “Crusading Mom Shrugs Off Vindication,” Star-Ledger, December 19, 2001.
Chapter Twenty-Four
1. Carol S. Rubin et al., “Investigating Childhood Leukemia in Churchill County, Nevada,” Environmental Health Perspectives 115:1 (January 2007): 151–57.
2. Craig Steinmaus et al., “Probability Estimates for the Unique Childhood Leukemia Cluster in Fallon, Nevada, and Risks near Other U.S. Military Aviation Facilities,” Environmental Health Perspectives 112:6 (May 2004): 766–71. The estimate that a childhood cancer cluster as large as Fallon’s would occur randomly only once every 22,000 years in a country the size of the United States (which had about 77 million children in 2003) is based on a case count of eleven childhood leukemias diagnosed in Fallon and the surrounding area from 1999 to 2001. The authors’ estimate that there was only a 1-in-232 million chance that the Fallon cluster was random is a sharp contrast to the Woburn childhood leukemia cluster, which the authors calculate had a 1-in-120 probability of occurring by chance. The authors did not attempt to estimate the odds that the Toms River cluster was random.
3. U.S. Centers for Disease Control and Prevention, Biosampling Case Children with Leukemia (Acute Lymphocytic and Myelocytic Leukemia) and a Reference Population in Sierra Vista, Arizona: Final Report (November 30, 2006).
4. Florida Department of Health, Acreage Cancer Review, Palm Beach County (August 28, 2009), subsequently revised as Acreage SIR Recalculation Population Estimate Methods and Results. Both are available on the Palm Beach County Health Department website. Because The Acreage grew so fast during the years at issue, the state calculated incidence rates using four different methods of estimating the local population. For the four cases of pediatric brain cancer diagnosed from 2005 to 2007, the 95 percent confidence intervals for the four methods were (1.7–11), (1.5–9.8), (1.3–8.2), and (1.3–8.2). Thus, by any of those methods, the cluster was statistically significant. Since three of the four cases were in girls, the incidence ratios and confidence intervals for girls were higher still.
5. Stephen P. Hunger et al., “Improved Survival for Children and Adolescents with Acute Lymphoblastic Leukemia Between 1990 and 2005: A Report from the Children’s Oncology Group,” Journal of Clinical Oncology, published online March 12, 2012. Gleevec, the Novartis trade name for the drug imatinib, is especially effective in treating children with ALL who carry the Philadelphia chromosomal translocation, the article notes.
6. The biggest dosimeter success story so far is for aflatoxin, a naturally occurring fungal secretion that is carcinogenic and often contaminates peanuts and other grains, especially in Africa and China. In the early 1990s, John Groopman of The Johns Hopkins University confirmed that aflatoxin-DNA adducts can be readily detected in urine and are a superb measure for identifying populations at high risk for liver cancer. See John D. Groopman et al., “Molecular Epidemiology of Aflatoxin Exposures: Validation of Aflatoxin-N7-Guanine Levels in Urine as a Biomarker in Experimental Rat Models and Humans,” Environmental Health Perspectives 99:3 (March 1993): 107–13.
7. One clue about the SUOX gene is that it produces an enzyme that is inhibited by tungsten exposure. That may be significant because unusually high levels of the naturally occurring metal have been found in the blood of Fallon children, both those with cancer and matched healthy controls. While case-control studies have not associated tungsten exposure with cancer in Fallon or anywhere else, it is possible that the gene variation may make certain children more vulnerable to tungsten-related toxicity. See Karen K. Steinberg et al., “Genetic Studies of a Cluster of Acute Lymphoblastic Leukemia Cases in Churchill County, Nevada,” Environmental Health Perspectives 115:1 (January 2007): 158–64.
8. Barry Finette’s Toms River research did uncover some suggestive evidence, but he was not sure what it meant, if anything. He found that small changes in three genes—a detoxifier on Chromosome One known as EPHX1, another detoxifier on Chromosome Eleven called GSTP2, and a DNA repairer on Chromosome Fourteen called APEX1—more than doubled cancer risk among children who did not live in Toms River. For Toms River children, however, the presence of the three genetic alterations did not significantly change their cancer risk. A more intriguing result concerned the gene ABCB1, on the long arm of Chromosome Seven. A drug transporter gene, it affects a cell’s ability to expel invading molecules that are capable of crossing complex bodily barriers, including the placenta that separates mother from child. Finette found that Toms River children were more likely to have one version of the ABCB1 gene than out-of-town children. But those differences in genotype did not match up with differences in cancer risk—at least, not that could be elucidated from such a small sample.
9. Barry Finette had been relatively optimistic about the chromosome damage study because there was already evidence from other studies that it was a useful biomarker for certain cancers and for exposure to some mutagenic chemicals. See, for example, Lars Hagmar et al., “Chromosomal Aberrations in Lymphocytes Predict Human Cancer: A Report from the European Study Group on Cytogenetic Biomarkers and Health,” Cancer Research 58:18 (September 15, 1998): 4117–21.
10. Another powerful motivation for manufacturers is that compounds deemed carcinogenic in National Toxicology Program rodent tests usually end up listed in the NTP’s Report on Carcinogens. The 2011 edition included 246 compounds—a blacklist manufacturers try to avoid at all cost.
11. National Toxicology Program, Draft NTP Technical Report on the Toxicology and Carcinogenesis Study of Styrene-Acrylonitrile Trimer in F344/N Rats (December 2010), 81, table 19.
12. For more about the limitations of 400-animal bioassays (50 per sex at four doses), see David Gaylor, “Are Tumor Incidence Rates from Chronic Bioassays Telling Us What We Need to Know about Carcinogens?” Regulatory Toxicology and Pharmacology 41 (2005): 128–33.
13. The Fischer 344 rat is a poor model for human leukemia because it is naturally prone to mononuclear cell leukemia, found only in rats. See Caldwell, “Review of Mononuclear Cell Leukemia.”
14. Compiled by Jerry Fagliano, data for the two charts in this chapter are from the New York State Cancer Registry and the New Jersey Department of Health and Senior Services. Incidence rates are diagnoses per 100,000 children per year and are age-adjusted to the U.S. population, as measured by the 2000 Census.
15. Daniel Wartenberg, “Investigating Disease Clusters: Why, When and How?” Journal of the Royal Statistical Society A 164:1 (2001): 13–22, 15.
16. Erika Bolstad et al., “Congress Urged to Track Cancer Clusters Better,” McClatchy Newspapers (Bradenton Herald), March 29, 2011. For a brief overview of proposed federal legislation, as well as descriptions of forty-two disease clusters reported in thirteen American states since 1977, see Kathleen Navarro et al., Health Alert: Disease Clusters Spotlight the Need to Protect People from Toxic Chemicals, a report of the Natural Resources Defense Council and the National Disease Clusters Alliance (March 2011).
17. The author interviewed parents and physicians at Chongqing Children’s Hospital in October of 2007.
18. As of 2007, the five-year survival rate for acute lymphoblastic leukemia among children who received at least some chemotherapy at Chongqing Children’s Hospital—one of the top facilities in China—was about 70 percent, compared to more than 95 percent for leukemia patients in the United States.
19. Lee Liu, “Made in China: Cancer Villages,” Environment (March/April 2010).
20. Xie Chuanjiao, “Pollution Makes Cancer the Top Killer,” China Daily, May 21, 2007. Published in China’s largest English-language publication, the article quotes Chen Zhizhou, a cancer researcher affiliated with the Chinese Academy of Medical Sciences: “The main reason behind the rising number of cancer cases is that pollution of the environment, water and air is getting worse by the day.”
21. Chemical production figures are drawn primarily from the “Facts and Figures of the Chemical Industry” survey published every summer by Chemical & Engineering News.
22. BASF, “BASF Chongqing MDI Project Approved,” news release, March 25, 2011.
23. For more about Frederica Perera and Deliang Tang’s research in China, see Frederica Perera et al., “Benefits of Reducing Prenatal Exposure to Coal-Burning Pollutants to Children’s Neurodevelopment in China,” Environmental Health Perspectives 116:10 (October 2008): 1396–1400; and Dan Fagin, “China’s Children of Smoke,” Scientific American (August 2008): 72–79.
24. The state cancer registry’s inadequacies, exposed during the 1996 crisis in Toms River, have not been completely resolved. But the current lag time of about eighteen months is less than half as long as in 1995, when Michael Berry had to abandon the idea of incorporating recent statistics into his cluster analysis. The diminished lag time is a direct result of pressure from Linda Gillick and the other TEACH families.
25. During the dry summer of 2005, United Water’s two senior executives in Toms River, General Manager George Flegal and Operations Manager Richard Ottens Jr., were so worried they might have to take wells offline due to radium contamination that they faked a safety test and filed a false report, according to state regulators. An audit by the water company’s home office discovered that the men had failed to report seven instances of elevated radium levels, prompting the state to fine United Water $64,000. The two were ousted from their jobs and fined $5,000 each. The company was also fined $104,000 for exceeding state-mandated pumping limits.
United Water’s new management in Toms River, however, has received a strong endorsement from Linda Gillick, who even gave the water company Ocean of Love’s 2010 Public Service Award. “I could not have imagined five years ago that I would be presenting this award to United Water,” she said at the ceremony. “The people at the company have earned my trust and respect through their commitment to honesty and integrity in everything they do.”
26. Like its corporate predecessor, Ciba, BASF has not been willing to spend the tens of millions of dollars it would cost to empty out Cell One of the lined landfill. The town has filed suit to try to force a Cell One cleanup, with the support of the TEACH families. Bruce and Melanie Anderson and their two sons have even picketed at the front gate of the shuttered plant to press for a cleanup. However, Ciba and now BASF have not relented, and the state Department of Environmental Protection, which is responsible for regulating the landfill, has not joined efforts to compel the company to remove the buried drums.
27. The excavation of the older dumps began in 2003, when workers pulled more than forty-seven thousand crumbling drums from the leaky pit of the old drum dump, which was on the site of an even older settling lagoon from the 1950s. Excavators then moved on to the other very old dumps scattered around the property. The original EPA plan had been for the soil from those dumps to be heat-treated in a thermal desorption machine, as had happened at Reich Farm in 1995, but the agency changed course after TEACH and other groups protested that the desorption process would generate toxic air emissions. However, the EPA refused to order Ciba to truck all of the chemical-laced soil to an off-site landfill, as TEACH and other groups wanted. Instead, for all but the most severely contaminated earth, the EPA allowed Ciba to use an experimental composting process. The tainted soil was mixed with straw, wood chips, nutrients, and water and then aerated to spur the growth of microbes that break down complex pollutants. After eight weeks of composting—first inside a shed the size of an airplane hangar and then outside, on an asphalt slab the size of a football field—the soil was tested. If contaminant levels were low enough, the dirt was then buried elsewhere on the factory grounds and another load of contaminated soil was brought in for composting.
28. Novartis, which inherited Ciba’s pharmaceutical business in the 1997 merger that broke up Ciba, still uses the Ciba name in its unit that makes contact lenses and lens care products, known as Ciba Vision. Ciba’s chemical products have been manufactured under the BASF corporate brand since 2009, when the German company bought what was left of the old Ciba.
About the Author
DAN FAGIN is an associate professor of journalism and the director of the Science, Health, and Environmental Reporting Program at New York University’s Arthur L. Carter Journalism Institute. For fifteen years, he was the environmental writer at Newsday, where he was twice a principal member of reporting teams that were finalists for the Pulitzer Prize. His articles on cancer epidemiology were recognized with the Science Journalism Award of the American Association for the Advancement of Science and the Science in Society Award of the National Association of Science Writers.
