Source: downtownexpress.com

By Julie Shapiro
7/10/2009

The city’s new description of how 9/11 affected children downplays the serious health risks those children could face, one doctor says.

Dr. David Carpenter initially worked with the city to draft the document, which is designed to help pediatricians treat children who were exposed to toxins released with the destruction of the World Trade Center. But Carpenter said the city rejected many of his suggestions, and before the city released the health guidelines last week, Carpenter removed his name from the list of authors.

“The guidelines were continually watered down,” said Carpenter, the director of the University at Albany’s Institute for Health and the Environment. “They were minimizing and trivializing things we felt were extremely important.”

In particular, Carpenter wanted to highlight the cognitive problems children could face after breathing in the cocktail of chemicals suspended in the air after 9/11. Those substances, including lead and P.C.B.s, have well-documented effects on children’s development, Carpenter said.

But while the report lists the potential health effects of those chemicals in a table, a footnote downplays the evidence, saying the impact of exposure for children is unknown. Other sections of the report, which talk about prenatal risks and the reasons children are particularly vulnerable to toxins, use qualifiers like “may.”

Carpenter agrees with the city that far too few studies have been done on children exposed to toxins on 9/11, which is part of why it took the city until now to complete the guidelines. But since doctors know which chemicals were in the air, and the cognitive effect those chemicals have had in other contexts, it isn’t much of a leap to extrapolate that those effects could be present in Lower Manhattan children, Carpenter said.

Instead, the city’s guidelines devote most attention to respiratory illnesses, a well-documented effect of exposure. Behavioral effects, like difficulty concentrating and poor school performance, are listed in the mental health section.

“The city Health Dept. wanted to downplay what are very real concerns and issues around environmental exposures and pass off any effect as being psychological, as opposed to physical,” Carpenter said. “You can pass anything off as psychological. It’s just an easy out.”

Lorna Thorpe, deputy commissioner of epidemiology at the Health Dept., said the city’s goal is to raise awareness of potential health risks, but the city does not want to overstate what is known and cause alarm, Thorpe said.

“It’s a challenge,” Thorpe said of balancing the two concerns. She added, “I don’t think we’re downplaying the potential for neurological impacts.”

Thorpe pointed out that all of the potential health effects Carpenter mentioned are listed in the report. Thorpe added that the doctors who worked on the pediatric guidelines had a range of opinions about how to convey the information, and some disagreed with Carpenter.

Dr. Pauline Thomas, a pediatrician who worked on the report, said it fairly represents what is known.

“It’s a question of evidence,” said Thomas, who did a study showing that children exposed to the dust cloud on 9/11 were more likely to have asthma.

The neurological impact of exposure is less certain, so it makes sense that respiratory effects received more attention in the report, Thomas said.

The community has long been pushing for the city to release the pediatric guidelines.

“It’s terrific that they’re finally available,” said Catherine McVay Hughes, chairperson of Community Board 1’s World Trade Center Committee. “It’s unfortunate that it’s taken eight years…but at least the children haven’t been forgotten.”

The city previously released two versions of guidelines for the treatment of adults.

Hughes said that while the pediatric guidelines might not be as comprehensive as some had hoped, they still contain important information that parents and doctors should know. Hughes led the community board in passing two resolutions calling for the city to consult Carpenter, who specializes in children’s environmental health issues, when drafting the guidelines.

The pediatric guidelines represent a major step forward in terms of the city acknowledging 9/11’s impact, said Kimberly Flynn, head of 9/11 Environmental Action.

Shortly after 9/11, the Health Dept. released a bulletin saying pregnant women and young children returning to their dust-covered homes did not have to take any extra precautions. The new guidelines describe for the first time the extra risks those two groups faced, Flynn said, even though the language is not as definite as she and Carpenter would have liked.

The 14-page guidelines provide doctors with physical and mental symptoms to look for, including difficulty breathing, chronic coughing, aggressive behavior, new fears and extreme dependency. The guidelines also include questions for doctors to ask parents and children and information on referring patients to Bellevue Hospital for more in-depth treatment. The city has posted the guidelines online (nyc.gov/html/doh/downloads/pdf/chi/chi28-4.pdf) and mailed them to more than 30,000 city physicians.

Bellevue hosts the city’s W.T.C. Environmental Health Center, which opened a pediatric clinic at the end of 2007. The clinic now serves about 50 children and has expanded its staff recently with a pediatric pulmonologist and a developmental pediatrician. Dr. Joan Reibman, the W.T.C. center’s medical director, hopes that the new pediatric guidelines will raise awareness about the center’s program for children, which offers care for no out-of-pocket cost.

Reibman also helped the city draft the guidelines, and like Carpenter, she had some concerns about the details, though she declined to go into specifics. But she did not remove her name from the final version of the report.

“We think it’s very important that the guidelines do come out,” she said. “They were collaborative — everyone compromised to some extent…. One could always make things better or more perfect.”

Thorpe, the deputy Health commissioner, said the city could revise the guidelines as more information becomes available about the impact of 9/11 on children. The city is now reviewing data from a follow-up survey of children who are part of the W.T.C. Health Registry, and Thorpe hopes to publish conclusions soon.