Host Steve Curwood talks with Jerald Fagliano of the New Jersey Department of Public Health and Dick Clapp of Boston University’s School of Public Health. They discuss the results of a five year study of a cancer cluster in Toms River, New Jersey that has made some association between chemical waste and childhood cancers. The case is similar to the Woburn, Massachusetts cancer cluster made famous in the movie "A Civil Action."
CURWOOD: For years, parents in Toms River, New Jersey expressed alarm that their children were suffering from seemingly high rates of cancer. And they blame the cancers on industrial chemicals that leeched from landfills into the town's drinking water. Recently, dozens of families reached an out-of-court settlement with the companies responsible for the pollution. And now, results of a five-year study confirm that at least some of that pollution can, in fact, be linked to the town's high incidence of childhood cancers.
The case hearkens back to a similar situation in Woburn, Massachusetts, highlighted in the movie A Civil Action. To help us compare the two cases, I am joined by Richard Clapp, Associate Professor of Public Health at Boston University. Professor Clapp was involved in the Woburn study and advised the Ocean County Health Department in the Toms River case. Professor Clapp, welcome.
CLAPP: Thank you.
CURWOOD: And Jerald Fagliano is with the New Jersey Department of Health and Senior Services. He was the lead researcher on the Toms River study. Dr. Fagliano, thanks for joining us today.
FAGLIANO: Thank you.
CURWOOD: Dr. Fagliano, what specifically did your study conclude?
FAGLIANO: Well, we found that female leukemia cases were five times more likely to have been exposed to one of the specific water sources that we were concerned about in the Toms River water system than were control children. This water source had been contaminated sometime early to middle 1980s.
CURWOOD: Why would there be a gender difference in the effect of this pollution exposure, Dr. Fagliano?
FAGLIANO: Well, we really don't have any idea why that particular finding occurred the way it did. The occurrence of cancer was elevated primarily among females to begin with. And we have no explanation for that, either.
CURWOOD: What was your biggest challenge in doing this study?
FAGLIANO: Well, there was a very simple question that we asked: whether or not children with cancer were more likely to have been exposed to specific water sources than control children? But that question evolved into a very complicated reconstruction of the environment on a monthly basis, over a 35-year period. So, it was a very complicated effort, not only to physically reconstruct the scope of the system, the pipe networks, the tanks, the well fields and the pumping patterns, but also to understand how that changed through time, over a very long period.
CURWOOD: Well, let's talk about these limitations of the study, Dr. Fagliano, just in terms of its ability to point the finger and say that this pollution caused this cancer. In fact, you don't do that in this study, so can you talk to us about these limitations?
FAGLIANO: Some of the factors that would inhibit us from drawing a direct link include the small numbers of subjects in our study, which is inherently a part of a cluster-scale investigation. We do not have a specific biological mechanism to be able to point to, and, as you pointed out, the male-female difference is something that we have no explanation for. On the other hand, these associations that we found are relatively strong, for an environmental epidemiology study.
CURWOOD: In general, Professor Clapp, what's your take on these limitations when you do epidemiological studies?
CLAPP: Well, I'm looking at this from a distance. I'm a person in Massachusetts, although I'm quite familiar with New Jersey and I'm quite familiar with the study and I've visited Toms River and so forth. And I am comparing what I've seen in Toms River with what happened in Woburn, and this, to me, is “second verse, same as the first,” or, Yogi Berra's line, I guess, was "deja-vu all over again." It seems very convincing to me that there's something going on here. There is, at least, one and perhaps two of the same chemicals involved, the same route of exposure seems to be the most significant--through the drinking water--and to me this is, I would say, almost like a replication of a finding that was pretty dramatic in the first place.
CURWOOD: Dr. Clapp, I think it was a colleague of yours over at Boston University who once said quote, "A public health catastrophe has a health effect so powerful that even an epidemiological study can detect it." How much are we expecting from these studies, too much perhaps?
CLAPP: I think too much, yes. You know, the average person thinks, “Well, it looks like a duck, it quacks like a duck, it walks like a duck, it must be a duck.” And epidemiologic studies aren't that clear. The fact that we can see things in a community setting like this in the first place is pretty remarkable.
CURWOOD: Dr. Fagliano, let me turn to you. How do you resolve the scientific standard, the very high standards and very precise nature that science wants to answer questions, with the desire for the public to know, on a public policy level, something?
FAGLIANO: Well, I think that the approach that we tried to take in Toms River is to involve the community and representatives of the community in as many of the steps of the design of the study as possible. One of the things that we tried to do is listen to the community's concerns about very specific sites or specific contamination problems in the past, and evaluate each one from the perspective of whether or not we could study that in this epidemiologic study.
CURWOOD: How have things changed politically, if at all, since the Woburn study?
CLAPP: At that time, in the 1980s, in this state, if you got too far out on a limb you could really not only lose your own career, your department could get its budget cut. And you could really be in some deep trouble for saying too much about what you thought caused something like childhood leukemia in the town of Woburn.
A lot of things have happened in the State Health Department in Massachusetts since then, whereby there is now a unit. It actually has something like 70 employees, that has actually several levels of investigation of these kinds of things: community-based health problems, cancer clusters, lupus or auto-immune disease clusters, and so forth. And they really do try to work in the way that Dr. Fagliano's described in New Jersey: with the community, listen to the community, not sort of freeze them out or shut them out of the process. There are more studies that are being done now. So, this is growing, the awareness of this kind of exposure and its effect on human health, or children's health in particular, has developed.
CURWOOD: Dr. Fagliano, what did you learn from studying Woburn?
FAGLIANO: Well, I think, as Dr. Clapp has mentioned, you can look at these two studies together now, and see, potentially, some patterns emerging that I think are of interest, of scientific interest and of public health interest. And both found connections between pre-natal exposure to pollutants, and not necessarily exposures in the post-natal period but particularly in the pre-natal period, which may indicate to us a particular window of vulnerability of children, of the developing human, to environmental pollutants. And I think, taken with information related to toxicology and other fields, I think there's been a confirmation of the fact that this is potentially a very important time period for epidemiologic investigation.
CURWOOD: Jerald Fagliano is an epidemiologist with the New Jersey Department of Health and Senior Services, and Richard Clapp is an associate professor of public health at Boston University. Thank you both for joining me today, gentlemen.
FAGLIANO: Thank you.
CLAPP: Thank you for having us.
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