Almost everyone had problems downloading the file of
the minutes from e?mail, so no one had time to review
them properly. Bill Pardue will review the file and make
changes, and send them for corrections by ~October 3.
They will be approved in the next PHAWG meeting.
Bill Pardue stated that he would like this agenda item
(Status of Action Items) to be a standard tool to be
used at all future PHAWG meetings to structure the meetings.
Regarding the Agenda for tonight's meeting (10/1/2001),
it was agreed that Item #7 should end with the word "Reports." With
that, the Agenda was approved.
Work is not yet complete on the matrix (to document
the process of PHAWG's reviews of epidemiological studies).
James Lewis and Susan Kaplan will report on it at a future
meeting.
- Draft resolution on Mangano Report
Al Brooks moved to make his resolution (passed out
at the 9/17/2001 PHAWG meeting) a Recommendation to
ORRHES. Pete Malmquist seconded.
Discussion:
Concern was expressed about making a Recommendation
regarding the Mangano Report before the matrix that
James Lewis and Susan Kaplan are working on is complete
because the two are so closely related. However, it
is not believed that the outcome of the matrix (on
the Mangano Report) will be significantly different
than what came out of the Work Group Meeting (08/28/2001).
It was generally agreed that the matrix form would
be the best way of presenting the topic to ORRHES;
therefore, the matrix should be a part of PHAWG's Recommendation
to ORRHES.
A question was raised about how PHAWG's evaluation
of the Mangano report can be useful in the Public Health
Assessment, since the Mangano Report does not deal
with I-131. However, the Mangano Report pertains to
general releases of radiation from the Oak Ridge Reservation
and the health of the nearby citizens. The exercise
(evaluation/critique of ANY epidemiological paper)
that PHAWG went through during its 08/28/2001 meeting
with Lucy Peipins, ATSDR epidemiologist) was meant
to provide PHAWG members with a useful tool (i.e.,
the ability to evaluate basic epidemiological studies
they may encounter as they try to perform the Public
Health Assessment).
Some people asked if PHAWG had afforded Mr. Mangano
any opportunity to respond to criticisms of his report.
The consensus was that any paper published in open
literature must be able to stand on its own merits.
PHAWG did view the videotape where Dr. Gould interviewed
Mr. Mangano about the report, and that did not change
the Work Group's conclusions about the report.
The full ORRHES Subcommittee was scheduled to hear
Part II of Lucy Peipins' Epidemiology Workshop, "Discussion
of the Mangano Report," on September 11, 2001.
Because of the "Attack on America," her presentation
was rescheduled to the upcoming December 2001 ORRHES
Meeting. There was discussion regarding whether PHAWG
should prepare a Recommendation to the Subcommittee
on this topic before or after we have had the opportunity
to hear Lucy's presentation.
Amendments to the Al Brooks Resolution:
- Bob Eklund moved that we amend the Al's resolution
to split Item 1) in the second paragraph to put a
period after the word "population," then
continue with the rest and footnote the last part
with a reference. David Johnson seconded. All in
favor. None opposed.
- Kowetha Davidson moved that we amend the resolution
to include the following 3 items:
- Second paragraph, first line: ". . . the
paper was rated low . . ." should be changed
to ". . . the paper was inadequate . . ."
- Third paragraph, first line: "the paper
also received a low rating in . . ." should
be changed to " . . . the paper was also inadequate
in . . ."
- Fifth paragraph, second line: ". . . establish
that airborne radioactive wastes . . ." should
be changed to ". . . establish that radiation
exposures . . ."
David Johnson seconded. All in favor. None opposed.
- Al Brooks moved that the matrix be added to his
resolution as an attachment. Bob Eklund moved to
amend Al Brooks' motion, subject to the approval
of PHAWG. (Mr. Brooks accepted this.) All in favor.
None opposed.
Bill Pardue called for a vote on Al Brooks' main motion
with above amendments. Seven (7) PHAWG members voted
in favor of the motion, 1 opposed, and 1 abstained.
Motion to make a Recommendation to ORRHES passed.
- Draft Letter to Dr. Koplan on Scarboro Environmental
Sampling
At the 09/11/2001 meeting of ORRHES, a representative
of EPA made a presentation on environmental sampling
of the Scarboro. Should ORRHES have been involved?
Kowetha Davidson feels that ORRHES should be involved
because the current sampling effort will expand to
Oak Ridge area-wide sampling (not just Scarboro).
Kowetha drafted the letter to Dr. Koplan, but the
Copy (cc) List is incomplete. She wants to copy the
people at the various agencies that have the authority
to act. She asked for and received input about who
in the various agencies should be copied on this letter.
Although public participation has indeed occurred
over the many years of this effort, everyone
feels it is important to find a way for continued public
interaction in this process. Although the work now
is done within an interagency working group (closed
to the public), we would at least like to have an ORRHES
member participate in the planning sessions. In this
way, we hope to bring more public confidence into the
process. Also, ORRHES may invite representatives from
this interagency working group to come to ORRHES meetings
and update us.
There were several suggestions on how to frame the
letter to get the responses we want. Bill Pardue asked
Kowetha to edit it and bring a revised draft back to
the next PHAWG meeting.
- Draft Letter to ATSDR on Secretarial Support
On the positive side, ATSDR did open an office to
support the work of ORRHES (something they have not
done for any of the other Health Effects Subcommittee
sites). We really appreciate having this facility and
the support we do receive. However, the level of support
is not sufficient if we are to accomplish our mission.
The office should be open to those Subcommittee members
willing to spend numerous hours of their personal time
working on ORRHES issues. Some Subcommittee members
(as well as members of the public who would like to
have access to the information in the ATSDR Office)
work or have other obligations during the day, and
need access to the ATSDR office at night. Bill Murray
cannot be there all hours of the day. But if he had
full-time secretarial support, that person and Bill
could stagger their hours as needed to provide extended
office hours for those who need them. Also, the ATSDR
Office should create and maintain much better records
for ORRHES members and for the public at large. Bill
Murray should be afforded sufficient administrative
support so that he could provide us ORRHES his technical
expertise.
Secretarial support should type major documents, create
and maintain files, produce meeting minutes, etc. Additional
duties are more clearly defined in the draft letter
to ATSDR that Mr. Pardue passed out in the 09/17/2001
meeting. This would make the ATSDR Office and ORRHES
function much more effectively.
Bill Pardue made a motion to send this Recommendation
to ATSDR. Susan Kaplan seconded.
Discussion:
We need to ask for exactly what we need. A set of "core
hours" that the office must be open should be
addressed. Reference materials are very important in
our work. They need to be available. We've been given
the facility - we really need to work with ATSDR to
make the best use of it and make it a functioning office.
There was discussion about how high in ATSDR's management
chain to send this Recommendation. The method of delivery
was also discussed (sending a letter in the mail vs.
hand-carry the letter and present our case in person).
PHAWG is aware of logistical problems for ATSDR in
trying to get a method in place to provide office support.
PHAWG members feel that there is a great deal of support
of all kinds at the ORRHES level, but the bulk of the
work is done at work group level and the individual
level. The Oak Ridge ATSDR Office needs to be able
to support all work.
Bill Pardue got the sense that everyone likes the
idea, but the draft letter needs to be strengthened.
Bill Pardue moved that this draft letter be referred
to a small subcommittee to be word smithed. James Lewis
seconded the motion. Seven PHAWG members voted in favor
of the motion. None against.
PHAWG members interested in volunteering to work on
the letter should do that and bring revised draft back
to next meeting.
- Discussion of Future Direction of the Work Group
Activities (Bill Pardue)
Were do we go from here? There are several issues
we need to address. Bill Pardue wants honest and free
conversation and ideas about these topics:
- What is function of this Committee?
- Are we rubber-stamping ATSDR's plans or are we
having input?
- We have been told by ATSDR that they will not deviate
from their long-standing process of developing a
Public Health Assessment (PHA).
- If we have sincere concerns, do we have ability
to change or question? Most of the group feels we
should have original input.
- Is the issue about Confidence Levels already decided?
Bill Pardue had this discussion with ATSDR people
recently, and they said they're not going to change
their process (for developing a PHA). **?[There is
a CIRCLA process of superfund sites that this community
has substantially changed for the better.]?** If we're
not going to be listened to, why bother?
We need an extremely well thought-out Mission Statement
for the Work Group. Are we going to look at additive
sources: ORR impacts on the world, or impacts of other
sites on the world?
Do we look only at health effects (what PHAs are about)
or are we looking at probable cause? Are we trying
to address public health issues, or are we laying out
the basis for lawsuits?
Free and Open Discussion:
Bob Eklund's comment on rubber stamping: The Work
Group should put forth a very good Recommendation and
see whether or not ORRHES adopts it.
Kowetha Davidson: As chair of ORRHES, she does not
think the Subcommittee should consider itself a rubber
stamp of ATSDR. High-caliber work should be done by
the Subcommittee such that ATSDR cannot ignore our
Recommendations. They have to respond (by law). The
ATSDR has a process in place to do this work; but that
should not be an influence on what Recommendations
the Subcommittee provides.
James Lewis: We are an advisory committee; ATSDR can
do what they want. Some in ATSDR listen and work with
us; others have canned processes. They are required
to give us response.
Susan Kaplan has never seen Recommendations from other
Subcommittees to be able to determine whether ATSDR
utilized them or whether they were blown off. Jack
Hanley said he provided that information in the 2nd or
3rd ORRHES meeting, but he will provide
another copy.
Al Brooks: We as ORRHES members have to express what
we believe. How much we can modify certain things is
open to question. Public Health Assessments do follow
a certain procedure; it's unavoidable. ATSDR has outlined
a procedure to deal with ALL contaminants of concern.
We had input. We have to make a case for what we consider
to be appropriate parameters to be used. We have to
present logical arguments. If they reject our reasoning,
they must explain why.
Bill Pardue: What do we do beyond the Public Health
Assessment? ATSDR does not run clinics. We'll hear
from a presentation from someone talking about setting
up clinics at one of the future ORRHES meetings. If
we recommend that, it could go to Congress; they'll
have to change the Charter of some agencies. Again,
we are ADVISORY - they don't have to accept any of
our Recommendations.
James Lewis: Oak Ridge is different from other DOE
sites. We have a field office. We have a different
process. Will ATSDR utilize the talent they have here?
Jackie Kittrell: What is reaction of ORRHES to PHAWG's
work? Do they rubber-stamp our work? Consensus: ORRHES
is required by FACA to discuss Recommendations. A lot
depends also on how effective the presentation is to
the full Subcommittee. Also, there are some ?internal
alliances? within the Subcommittee that influences
votes as well.
Al Brooks said ORRHES was set up so that work group
members do all the work.
Susan Kaplan: There was never a project plan or flow
chart for any other Subcommittee.
Bob Eklund: How interactive have we been when ATSDR
needs us to work with them? If we want them to interact
with us, we should interact with them.
Al Brooks : They come in with experts that are no
more expert than some of us.
James Lewis has been generally impressed with the
quality of the presentations by experts at ORRHES Meetings.
Examples: Lucy Peipins and Michael Grayson have given
presentations to both the full Subcommittee and our
Work Group. As presenters, Charlie Miller and Lucy
Peipins especially broke down very technical information
to layman's level.
Kowetha Davidson: We now have to extract the information
that we can use from all those presentations. If there
are additional questions, we need to get those answers.
Now we need to use the information we've been given
Jack Hanley: If you look at the flowchart, Phase II,
we (ATSDR) presented information about iodine. Any
outstanding issues and concerns should be fed back
to us through the Subcommittee. We're open to hear
issues. We know the Work Group has outstanding issues
on iodine. Those were outlined those a few meetings
ago. Please provide a little more feedback. The same
thing applies on screening of past exposures that the
State conducted. There has to be more give and take.
Communication issues need to be ironed out. This whole
process is totally new. Typically a report is written,
we put it out for comment for 2 months, and that's
it.
Michael Grayson, on the other hand, does not believe
what they are doing in Oak Ridge, in terms of involving
the community, is extremely new. But at other sites,
public gives input which is not extremely substantive.
He understands Bill Pardue's comment on rubber-stamping.
At Oak Ridge, he got down to community members' level
walked them through the process; he also met with some
of the PHAWG members individually. Some people in ATSDR
had problems with our concerns. He sent some of that
information back to PHAWG, but we didn't see it. He
sent it to Bill Pardue to refine and send out to the
Work Group members. LaFreda advised Michael not to
send the information to the rest of the Work Group
without Bill first having ?blessed it.? There was some
apparent miscommunication because Bill did not realize
he was supposed to do that. The Work Group and Bill
Pardue asked Michael to send this information directly
to the entire Work Group.
Michael Grayson stated the ?doses are already calculated?
(using the ATSDR Public Health Assessment Guidance
Document, or the ?big blue book?). ?We have to decide
how to use them.?
There was another discussion specifically about Confidence
Intervals. Some very technical information on the topic
was faxed to Bill Murray today, but it is not good
reading for the average person.
Michael Grayson wants PHAWG to make him a list of
things we want to know about uncertainty analysis.
Does PHAWG want ATSDR to use a certain percentile?
Grayson's focus is: ?what does the outcome mean??
Brooks: Grayson has the list of PHAWG's concerns about
I-131, but the list has not been prioritized.. We owe
him a Recommendation in writing.
James Lewis: As a lay person, I have weaknesses in
trying to understand this issue. Somebody out there
has had experience giving understanding to lay people
on uncertainty analysis. We need to find the right
presenter.
Bill Pardue: There's an argument that can be made
that we don't need to do much at all about uncertainty
analysis. Owen and other who have looked at health
effects from RaLa project estimate 20 to 30 probable
cancers. If other factors are added, we would estimate
an additional 20 to 30 cancers. A total of 100-120
cancers over 70-year period is likely. We may accept
100. We might make suggestion that any female of a
certain age who drank backyard cows milk go to her
doctor and be screened for thyroid disease. Use the
worst-case scenario.
Al Brooks: Public will interpret that differently.
If that's the approach, we may indeed be laying foundations
for lawsuits.
Bill Pardue: Owen Hoffman said no matter what percentile
is used, it would not dramatically change number of
health effects. We could vary between two extremes
and see what come up with. Or we could vary between
the central value and the maximum.
Kowetha Davidson: In toxicology, we learn to keep
the range reasonable. She advises keeping it between
central and maximum.
There is a lot of interest in non-cancerous health
effects (e.g., thyroid disease). Michael has a National
Academy of Sciences document on the range where the
threshold takes place (cancerous vs. non-cancerous
health effects), and he wants to go over that information
with the Work Group.
Charlie Miller said at the ORRHES Meeting that if
he had a daughter that fit most of the categories of
concern (time period, geographic area, drank backyard
cow or goat milk, etc.), he would make sure she were
periodically checked by her doctor.
Bob Eklund reiterated that whatever we decide on as
numbers, that's not as important as knowing you fall
into this category get yourself checked by your physician.
He also commented that the medical community won't
respond if there is fear that results would lay blame
on the Oak Ridge Reservation.
Jack Hanley followed up by saying that ATSDR can have
experts come in and inform doctors how they might better
identify people who fall into potential risk categories
based on what they may have been exposed to in certain
populations, certain years, etc.
L.C. Manley said we should be careful not to infer
(again) that Oak Ridge physicians are afraid to diagnose
diseases correctly for fear of reprisal. Those accusations
have been made before, and were not substantiated.
David Johnson: Everyone can't afford the medicine
they need (but we are not in a position to do anything
about some issues - like this one).
There was some further discussion about medical treatment
in general, the part insurance/HMOs play, particulars
such as PACE's state-of-the-art Catscan in a trailer,
etc.