Public Health Assessment Work Group
Meeting Minutes
September 17, 2001
Agenda
- Approve minutes of PHA WG meetings on 7/19 (addenda), 8/6, 8/20,
8/28 (see attachments) - Bill Pardue
- View videotape of Joseph Mangano on his report "Cancer martality
near Oak Ridge, Tennessee"
- Review/approve draft recommendation on the Mangano report for presentation
to ORRHES - Bill Pardue
- Discuss draft recommendation on need for secretarial support from
ATSDR for ORRHES activities - Bill Pardue
- Brief introduction on ATSDR approach to screening for contaminants
of concern - Jack Hanley, Karl Markiewicz
- Discuss priorities and approach for PHA WG near-term activities,
(time permitting), e;g.:
- letter on environmental sampling in Oak Ridge
- case history files
- I-131 considerations
- other (bring your thoughts)
Attendees:
Al Brooks
Kowetha Davidson
Bob Eklund
Karen Galloway
Linda Gass
Michael Grayson, ATSDR
Jack Hanley, ATSDR
David Johnson
Susan Kaplan
Mike Knapp
James Lewis
L.C. Manley
Karl Markiewicz, ATSDR
Donna Mosby
Bill Murray, ATSDR
Bill Pardue
Paul Parson, The Oak Ridger
Bob Peelle
Barbara Sonnenburg
Summary
The meeting was called to order by Bill Pardue, PHAWG Chair, at ~5:30
p.m.
1. Approve Minutes of PHAWG Meetings for 7/19, 8/6, 8/20, 8/28 (Bill
Pardue)
The first item on the agenda (Attachment 1) was to approve the minutes
of the last several meetings. The minutes of the August 6, 2001, meeting
stand as they are. The minutes of August 20, 2001 Revised Draft
was developed by an Eastern Research Group (ERG) person over the
phone. PHAWG is going through a process of deciding how Work Group meeting
minutes will be developed in the future.
Discussion:
July 19 Minutes: Stand as they are with the attached statement (agreement)
from Owen Hoffman.
August 6 Draft Minutes:
Item 3, 3rd sentence, should read "The Public Health Assessment
Work Group (PHAWG) in conjunction with ATSDR has developed . . .
Item 7: The bullet that is now shown as an "8" should be a
regular bullet.
Item 7: First bullet also, it indicates "completed." Should
read "Completed by ATSDR" (because it is not yet completed by
the PHAWG).
September 5 Revised Draft Minutes (of the August 20, 2001, Meeting):
Page 3, Issue #2, second from last line of 1st paragraph: . . . evaluation
form (not forms) before going . . .
Page 3, Issue #3, last paragraph: "This will be read into the minutes."
Which minutes? Should read "This will be read into the minutes of
the next meeting."
The words "The Chair" should not be capitalized.
Attachment, "Process for Developing PHAWG Minutes"
Page 1, under Details, 3rd line: Delete word "highlight".
Mr. Brooks stated that all action items, major conclusions, etc., should
be recorded verbatim and read back at least three times by the recorder
of minutes in order to assure accuracy. The PHAWG Chair is responsible
for notifying the recorder whenever she is to take minutes verbatim.
Strike "who is not a member of the PHAWG." Minutes will be
prepared by a party who is not an ATSDR staff member."
General Comment on Meeting Minutes: The level of detail of the PHAWG
Meeting Minutes has varied. Detailed minutes of these meetings will be
essential for many reasons. Subcommittee members who come onboard late
(or anyone else who becomes involved in this process in the future in
any capacity) must be able to read minutes of meetings and be able to
grasp the issues that have been addressed in the past. We should maintain
copies of electronic medium (audio/video tapes) to back up the minutes,
and file them with the record copies of meeting minutes.
All voted in favor of approval of the minutes as amended, except Barbara
who abstained because she wasn't here for the meetings.
The question was asked, "what do we do if someone challenges the
minutes?" Kowetha Davidson stated that approved meeting minutes are
final; however, corrections can be read into subsequent meeting minutes
at a future time.
2. The PHAWG viewed a ~20-minute videotape of Dr. Jay Gould, author of
Deadly Deceit, interviewing Joseph Mangano about the findings published
in Mr. Mangano's paper, "Cancer Mortality Near Oak Ridge, Tennessee."
The PHAWG made a previous promise to actually watch this videotape before
addressing any Recommendation to the ORRHES about the Mangano paper.
3. Review/Approve Draft Recommendation on the Mangano Report for Presentation
to ORRHES (Bill Pardue)
General Comments Following the Viewing of the Videotape: Most participants
agreed that Mangano did not prove his hypotheses. They also felt Mangano
was not familiar with the surrounding counties and layout of the Oak Ridge
Reservation. They generally disagreed with Mangano's comparisons which
used changes in cancer rates, rather than true cancer rate data. Al Brooks
made one clear illustration of this:
Period R1 Period R2 % Change
High incidence (#) 80 100 25
Low incidence (#) 2 4 200
Dr. Brooks asked: "Which area would you rather live in - the area
that had 2 instances of cancer and later there were 4 (with a 200% change
in cancer rate), or the area that had 80 instances of cancer and later
there were 100 (with a 25% change in cancer rate)?
There was a lengthy discussion of wind direction as it pertains to Mangano's
findings. It is generally accepted that wind goes from Southwest (SW)
to Northeast (NE).
Al Brooks showed National Cancer Institute (NCI) maps which display cancer
rates to the Work Group. Two basic viewgraphs were shown, one depicting
cancer rates in the United States for white males in the years 1950 to
1969, and the other depicting the same for years 1970 to 1994. Red color
(on the map) indicates highest incidence of cancer; white (blue??) indicates
the lowest. The viewgraph depicting years 1950-1969 indicate low-to-high
rates of cancer in the Southeast area of the U.S. (noticeably higher than
in other regions of the U.S.). The viewgraph depicting years 1970-1994
indicate a much higher incidence of cancer for the Southeast (more red
than before). Overall, the Southeast area of the U.S. has a very large
regional problem. It is concluded that it is hard to see how the Oak Ridge
plants were responsible for this trend.
There was discussion about Cocke County, Tennessee, where the cancer
rate has always been very high. Dr. Brooks stated that cancer data from
NCI disputes some of Mangano's findings. Mr. Mangano made a point about
effects of poverty, mountainous terrain, and rainfall (Mangano assumed
the more mountainous terrain, the more rainfall). Dr. Brooks stated that
wind blowing in a southwesterly direction does not account for how radioactivity
got to Morgan, Scott, and Campbell counties (mountainous terrain) in the
first place (wrong wind direction if you go with Mangano's theories)?
The highest rainfall in this region is in Smokey Mountains. Another confounding
piece of information: In lots of the counties with highest cancer rates
for white men, the rates for the females in the same counties were low.
In summary, the data is "hit and miss" and it is hard to draw
a distinct correlation with emissions from Oak Ridge plants.
Al Brooks also looked at wind rose data (by year). Oak Ridge has been
very thoroughly studied. Dr. Brooks stated that Oak Ridge is one of the
most wind-free places around. At ground level, wind blows both ways: NE
to SW, as well as SW to NE. At 500 meters, it starts to go predominantly
SW to NE. At night, the wind direction reverses. Most people are only
awake during daytime hours and only notice wind blowing from SW to NE
direction.
Mike Knapp expressed concern that the State does not keep adequate data
on cancers of all types, including non-fatal cancers. He also stated a
need for a decent tracking system to determine what the health impacts
are of all pollutants. Mr. Knapp does not want us to review these papers
(Mangano's or any others we may review in the future) with the purpose
of finding their failures; he asked, "what do we gain from that?"
He believes we should be able to find some "lesson learned"
with each one. Mr. Knapp feels that ORRHES should make a recommendation
for the Tennessee Department of Health to improve it's health quality
data collection and reporting system, not just cancer mortality data.
James Lewis said that Mr. Mangano had the responsibility to qualify his
data. Bob Eklund stated that any medical student or scientist learns to
read reports with a critical eye.
Before making "recommendations," James Lewis said it is his
opinion that we should learn all we can from experts who look at this
type of data and this type of problem all the time (like Charlie Miller,
Owen Hoffman, and others who have similar expertise).
Bill Pardue said that PHAWG has previously agreed to provide a recommendation
to ORRHES about the merits of Mangano's report and whether or not we should
use it in the Public Health Assessment. It does not appear the data used
were of the quality/accuracy we would want. If we say "Yes, we should
use this report in the Public Health Assessment," we affirm that
Oak Ridge has made a significant contribution to cancer around reactor
sites. Mangano shows a 30-50% increase in cancer caused by ½% increase
in radiation.
Kowetha Davidson made this point: Mangano did not account for cancer
due to smoking. That cannot be ignored because such a large portion of
the population smoked.
It was generally agreed that we need to be looking at the cancer diagnosis
(or incidence data), not mortality data because many people who have cancer
actually die of something else. Bob Peelle added that incidence data only
started being available in the mid 1990s. Al Brooks stated that even incidence
data will not be entirely accurate (e.g., years ago, cancer was not often
diagnosed because of the "stigma").
James Lewis commented that Lucy Peipins (ATSDR epidemiologist) provided
us with the basic criteria for evaluating epidemiologic studies. We need
to set up a matrix where our evaluations/conclusions on each paper can
be documented and presented is an organized and structured manner. This
matrix should be available for general review (by non-Work Group participants).
That way, people who come onboard with this effort in the future can see
and evaluate the Work Group's review efforts.
A draft recommendation to the Subcommittee, prepared by Al Brooks, was
passed around.
Bob Eklund said we should take "the reasons" and PHAWG's conclusions
(about Mangano report) and submit them to the Subcommittee. Bill Pardue
stated that the entire package of minutes (from the 08/28/2001 PHAWG Meeting
where Lucy Peipins led us through the exercise of evaluating an epidemiologic
study, which happened to be the Mangano report) contains "the reasons."
Bill Murray: There are limitations; exposures were not measured. Radiation
does not cause all types of cancer. Cancer may not be best outcome.
Bill Pardue: Everyone's voice must be heard, but we need to make a decision.
Bob Eklund: "I make a Motion that we take data from minutes of the
August 28 meeting and allow James and whoever wants to help him . . ."
Barbara Sonnenburg: Second.
Bob Eklund: "I'd like to make an amendment that James (Lewis) as
he's preparing his matrix document, try to include Al's points" (in
his draft recommendation).
Bill Pardue: Al's recommendation, James Lewis's matrix, and the minutes
should be considered and voted on in our next meeting.
Bill Pardue: It is premature to vote on Al's recommendation without having
time to study it.
There was some discussion about the minutes of Lucy Peipins' meeting
(08/28/2001). Barbara Sonnenburg did not understand that all the comments
which were recorded were those of the Work Group. The misunderstanding
was cleared up.
James and Susan are preparing the matrix between now and the next meeting.
They will get it to the Work Group a few days in advance of meeting to
consider. Members of Work Group were asked to (1) consider Al's recommendation,
and (2) re-read minutes of the meeting we had with Lucy now that we all
understand how they came about.
4. Discuss Draft Recommendation on Need for Secretarial Support from
ATSDR for ORRHES Activities (Bill Pardue)
Bill Pardue handed out a draft letter requesting secretarial help for
the ATSDR Office in Oak Ridge. We will vote on it next time.
5. Brief Introduction on ATSDR Approach to Screening for Contaminants
of Concern (Karl Markiewicz)
This October and November, ATSDR staff will make several visits to Oak
Ridge. Michael Grayson, Jack Hanley, Mark Evans, and Karl Markiewicz would
like to have discussions with PHAWG. Any questions or issues can be addressed
to them at that time. Jack and Karl have both prepared a Case File regarding
past screening efforts. Most information in that binder has been handed
out to Work Group already. They would like to bring closure to some contaminants
and move on to others. Presentations will be ~2 hours long. A sample draft
Case History, prepared by ATSDR, was made available for Work Group review.
6. Discuss Priorities and Approach for PHAWG Near-Term Activities (Bill
Pardue)
Letter on Environmental Sampling in Oak Ridge
Kowetha Davidson distributed a draft letter to ATSDR on ORRHES concerns
regarding public input to sampling, for consideration at PHAWG's next
meeting.
Case History Files
James Lewis noted that he had performed a cursory review of the Case
History File submitted by Karl Markiewicz and Jack Hanley (ATSDR). He
thought they were all-inclusive, but they were not indexed in accordance
with the procedure outlined in the previous PHAWG Meeting.
I-131 Considerations
Bill Pardue will solicit input from everyone by the next PHAWG meeting
on the list of issues that were documented in the last PHAWG Meeting and
establish their priority. Some members of the Work Group thought that
Michael Grayson (ATSDR) should have acted on that list of 10 bullets.
We owe Michael a formal recommendation to request Case History Files from
ATSDR so he can take it to his management. We did a brainstorming exercise
to list our issues, but we expected technical experts to give us presentations
for each of these.
Michael Grayson asked volunteers who can work with him to sit and help
him with this. James Lewis asked Mr. Grayson to write down exactly what
he needs from PHAWG. Michael Grayson stated that his management doesn't
like for him to write things down - they want him to be very verbal.
PHAWG has concern about not being able to get anything in writing from
Grayson.
Kowetha: We should discuss issues with Michael and tell him what we want/need.
What presentations do we need to better understand the issues?
Michael Grayson stated that he's been to Oak Ridge and heard PHAWG's
concerns several times. He has come back to ATSDR and written them up
several times. His goal is to have someone talk about Monte Carlo uncertainty
analysis and how to use the results. He will sit down and address/prioritize
which of concerns needs to be presented, develop objectives, and find
presenters to deliver these objectives.
Bob Eklund asked if Michael Grayson can make presentations to PHAWG and
let us ask questions and see how it goes. Michael stated that he is not
qualified to speak on all those subjects (from the 10 bullets). Michael
wants PHAWG to write down issues related to uncertainty analysis that
we would like to discuss, then he'll find a presenter (he prefers an outside
person). Michael Grayson stated that the only goal he has is whether we
should use central values, or upper bound.
Mike Knapp suggested Owen Hoffman as a possible presenter.
Before PHAWG's next meeting (October 1), PHAWG members should compile
any additional questions for Michael and send them to him via e-mail
Michael Grayson: They have already determined this criteria at ATSDR,
and he needs us to read the "Big Blue Book" to match our (PHAWG's)
criteria with their (ATSDR's) criteria. Michael asked for a commitment
for PHAWG members to read the first two chapters on adding doses (40+
pages); also, he wants PHAWG members to commit to read section on calculating
individual doses. Susan Kaplan said if he would send it to her, she would
read it.
Bill Pardue adjourned the meeting at ~9:15 p.m.
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