ATSDR - Subcommittee on Interior, Environment, and Related Agencies Committee on Appropriations US Senate

Agency for Toxic Substances and Disease Registry

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Testimony
Tom Sinks, Ph.D.
Director
Agency for Toxic Substances and Disease Registry

Provided to the

Subcommittee on Interior, Environment, and Related Agencies
Committee on Appropriations
United States Senate
Washington, DC

May 5, 2005

Mr. Chairman and distinguished Members of the Subcommittee: The Agency for Toxic Substances and Disease Registry (ATSDR) is pleased to provide written testimony in support of the President's FY06 budget request of $ 76.024 million. This funding will support ATSDR's ongoing activities and critical programs, including programs to enhance the understanding of health impacts from exposures to hazardous substances.

As an agency newly under your jurisdiction, we would first like to introduce ourselves. We will then discuss some highlights of ATSDR's Superfund site work, demonstrating how the Agency has been successful in meeting its goal to mitigate the risks of health effects at toxic waste sites and how we have assisted the Environmental Protection Agency (EPA) in documenting the need for and effectiveness of its remediation efforts. This testimony will address (1) ATSDR's achievements in carrying out its mission under the Superfund to assess potential health impacts from exposures of hazardous waste sites; (2) ATSDR's education of the public and the medical community to mitigate potential health problems facing communities around the nation; and (3) ATSDR's partnerships and their protective impact on the public's health from hazardous substances.

INTRODUCTION

What is ATSDR? A community discovers its drinking water is contaminated with a toxic substance that came from the local landfill... An Indian tribe has concerns about mercury in fish and wild game... A child is found to be suffering from exposure to high levels of lead... Basements in a neighborhood have annoying fumes that smell like gas or oil... What health effects might have occurred, or will occur, as a result of these exposures? These are the types of environmental health issues that ATSDR addresses every day.

ATSDR was created under the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA), more commonly known as the Superfund law. The Superfund program is charged with finding and cleaning up the most dangerous hazardous waste sites in the country. ATSDR supports this mission by providing and using the best science, taking responsive public health actions, and providing trusted health information to prevent harmful exposures and disease related to toxic substances.

ATSDR ACHIEVEMENTS

All the work we do is geared toward meeting the overarching goal of ensuring that the sites where we work become healthy places to live, work, and play.

Protecting the Public's Health by Addressing Asbestos Exposure: Our work in addressing health problems associated with exposure to asbestos is an example of our efforts. The asbestos exposures that took place in Libby, Montana, have become well known since ATSDR studies and screening defined the extent of the health problem. ATSDR medical screening revealed that:

Nearly one in five of the 7,300 people participating in the medical testing during the years 2000 and 2001 were found to have lung or breathing abnormalities associated with exposure to asbestos fibers.
Of the former W. R. Grace employees receiving x-rays, 51% had pleural abnormalities.

In addition, an updated analysis of deaths due to asbestos-related disease in the Libby area from 1979-1998 showed increased mortality due to asbestosis, lung cancer, and other, non-malignant respiratory diseases. We are continuing to provide medical screening for exposed individuals and have established a registry to track their ongoing health status.

But the contamination was not limited to Libby; the asbestos contaminated vermiculite was shipped for processing to over 200 plants around the country. ATSDR is now studying the 28 sites that received nearly 80 percent of the Libby vermiculite mined from 1964 through 1980. The findings from studying these sites will indicate whether the scope of the project needs to be expanded to include other sites that processed Libby vermiculite and the associated health concerns. The 28 pilot sites are scattered across the U.S. and include locations in California, Colorado, Maryland, and North Dakota. ATSDR is working to determine whether past (or current) exposures took place at or near these sites-paying particular attention to former workers and their families. The Agency will then work with community residents and state partners to mitigate any existing or potential health effects. Health statistics reviews to evaluate mortality and cancer registry data are under way in sixteen states, and pilot mesothelioma surveillance is being initiated in the states of New York, Wisconsin, and New Jersey.

Another unfolding asbestos-related challenge is in El Dorado Hills, California, where workers found a vein of naturally occurring asbestos during construction of a soccer field at Oak Ridge High School. ATSDR has evaluated the public health threat associated with exposures to airborne asbestos fibers at the school, and will be documenting its findings. ATSDR will continue to consult with state and local agencies and the EPA to address this issue.

Meeting the Goal to Mitigate the Risks of Human Health Effects at Toxic Waste Sites: Communities around the country benefit directly from ATSDR's assessment and interventions concerning potential exposures to hazardous substances and related risks of adverse health effects. Indeed, ATSDR has made significant strides in the past year at documenting the effectiveness of Agency recommendations and interventions to reduce community members' risk of adverse health effects. The Agency and its state partners work on hundreds of Superfund sites each year to evaluate the health hazards at these sites. Many are found to pose a public health hazard-sites where children and other residents suffer from potentially harmful exposures.

Examples of Superfund sites where ATSDR's recommendations and interventions have helped people include the following:

Tar Creek, Oklahoma—ATSDR-sponsored activities have helped produce a significant drop in blood-lead levels (BLLs) among young children in Tar Creek. In 1996, data from the Oklahoma State Department of Health (OSDH) showed that among young children (aged 1-5 years) living at the site, 31.2% had a BLL at or above 10 micrograms per deciliter (µg/dL), the Centers for Disease Control and Prevention (CDC) level of health concern. By 2003, OSDH data indicated that elevated BLLs among children in the same age group had dropped to just 2.8%.
Las Vegas, Nevada—ATSDR expertise helped limit injuries from mercury spilled in a Las Vegas home. Over a 2-3 month period, a 17-year-old resident spilled approximately one quart of elemental liquid mercury inside and outside his home. When the boy was hospitalized for severe mercury poisoning, EPA emergency personnel checked the home and found toxic mercury vapors up to 150 times higher than acceptable levels. One sink's drain trap contained as much as two tablespoons of the metal. With the help of ATSDR guidance on cleanup levels and handling of mercury-contaminated household items, EPA was able to clean the house and eliminate further exposures. ATSDR also coordinated with health officials in California to ensure that several part-time members of the household who had been exposed but who were in California at the time of the investigation also received medical follow-up.
Eureka, Utah—Interventions by ATSDR and state efforts have helped decrease average blood-lead levels (BLLs) in children living in Eureka, where mining activities conducted from 1870 to 1965 resulted in elevated levels of metals in the soil. Children in this community are 10 times more likely to have elevated BLLs (at or over 10µg/dL) than children elsewhere in Utah. The Utah Department of Health, in cooperation with ATSDR, has developed a successful new health education program designed to encourage blood-lead testing for residents and to decrease average BLLs in children. The program reaches approximately 110 Eureka Elementary students twice per month. Cleanup by the EPA and the Utah Department of Environmental Quality has resulted in a return to blood-lead levels below the threshold of health concern. Blood-lead testing since 2000 indicates that BLLs among children in Eureka have dropped and stabilized, although average levels in the city's children remain high compared to the state average.
Bunker Hill Mining and Metallurgical Complex/Couer d'Alene River Basin, Idaho—ATSDR has been engaged for several years in evaluating the public health impact of metals released during mining and smelting operations at the Bunker Hill site. Although ATSDR has identified seven chemicals of potential concern, including aluminum, antimony, arsenic, cadmium, iron, manganese, and zinc, the contaminant of greatest concern at the site is lead. In late 2004, ATSDR released for public comment a public health assessment (PHA) that concluded that (1) high levels of lead and other metals exist in surface soil, household dusts, and fish at and near the site; (2) possible long-term exposure to contaminants existed in a variety of media; and (3) site conditions have resulted in elevated blood lead levels in some children. The PHA's recommendations include conducting further testing of surface soils and household dusts throughout the River Basin site and remediating or covering contaminated soil in children's play areas at residences and common use areas.

ATSDR EDUCATION OF THE PUBLIC AND MEDICAL COMMUNITY

ATSDR also proactively works with EPA and the states to provide a variety of resources and technical support services, including emergency response, publication of toxicological profiles, and referral to environmental health specialists. ATSDR assessments and interventions concerning potential exposures to hazardous substances serve as an important link between health and environmental agencies and stakeholders. For example:

ATSDR published and distributed more than 12,000 copies of toxicological profiles, each one on CD-ROM containing information on more than 800 chemicals. These profiles are considered the authoritative source of up-to-date information on the known health effects of these chemicals by federal, state, and local health and environmental officials, as well as by private industry.
ATSDR supports the network of Pediatric Environmental Health Specialty Units in major medical centers in all 10 EPA/HHS regions of the country. These units provide pediatricians and other health care providers with experts on how best to diagnose and treat patients exposed to such chemical contaminants as lead, mercury, or dioxin.

ATSDR PARTNERSHIPS AND HEALTH IMPACTS

ATSDR leverages resources and partnerships to maximize health impacts. ATSDR has an extensive state cooperative agreement program and research partnerships with organizations such as the American Chemistry Council to improve and facilitate capacity-building in environmental health.

Terrorism: ATSDR has a significant role in planning for and responding to the threat of terrorist events, including performing emergency service functions of the National Response Plan. ATSDR's staff, located in EPA regional offices, work daily with EPA and regional staff and state partners to provide expertise in planning for and responding to chemical emergencies. ATSDR has responded and participated in several public health emergencies of this nature, including the ricin incident at a South Carolina post office.

Strengthened Ties with EPA and Documented Health Improvements Post-Remediation: Another measure of success ATSDR has established is the percentage of ATSDR recommendations that EPA adopts. More than 70% of our recommendations for site action directed to EPA in 2003 have been implemented by EPA, with 10% still pending decision. We also play a critical role in helping EPA and state site managers to prioritize and identify which sites pose the greatest threat to human health.

Further, in this past year we have been working with EPA to support its remediation actions by measuring the effectiveness of its clean-up efforts in reducing adverse health effects. One of the best examples of that work is our joint effort at the Doe Run Smelter, in Herculaneum, Missouri. BLLs for children in the town are decreasing following EPA's remediation of lead sources and ATSDR-sponsored health education and intervention activities. In 2001, 28% of 118 young children (aged 6 to 72 months) tested had elevated BLLs. Of the 67 young children living within a half mile of the smelter, 30 (45%) had BLLs at or above 10 µg/dL, the level of concern set by CDC, and ten times the percentage of children with such levels nationally. Results were evident by the following year. By 2002, just 14% of the children tested had elevated BLLs. Similarly, of the young children living within a half mile of the site, only 17% had an elevated BLL. Another strong example of ATSDR work in support of EPA is a study that demonstrated that removal of lead-contaminated soil from residential yards in Idaho's Silver Valley was effective in reducing blood lead levels in children.

Other examples of sites where strong partnerships have led to positive results include:

Beloit, Wisconsin—Wisconsin's Department of Health and Family Services (DHFS) and ATSDR helped a business owner in Beloit protect people from breathing hazardous levels of volatile organic compounds (VOCs). Investigating odor complaints from occupants of a building, state health officials detected high levels of VOCs in the air. The VOCs, apparently from fuel oil-contaminated water seeping into the basement, posed an intermittent, short-term health hazard when vapors from the basement entered the main building. DHFS consulted with the building's owners and recommended interim measures to prevent exposures. The suspected source, an underground fuel oil tank on an adjoining property, is now slated for removal. Health officials will follow up to ensure that the measures were effective.
Huntington, West Virginia—ATSDR expertise and guidance helped the West Virginia Cooperative Partners Program (WVCPP) and local health officials protect residents and school children from exposure to benzene, a known carcinogen. When a railroad-car valve failed at the TechSol facility in Huntington, some 23,000 gallons of coal tar light oil spilled into Kraut's Creek and into storm sewers. The spill forced people in over 500 homes and an elementary school to evacuate. To ensure that people returning to their homes would be safe, WVCPP, an ATSDR partner, determined safe reoccupation levels and conducted indoor air tests. As a result, most of those evacuated were able to return two days later. WVCPP is now working with the community to address concerns about exposure, and cleanup of the creek continues.

We look forward to working on these and additional challenges in the future. We thank you for the opportunity to provide you with written testimony and we look forward to responding to any questions you may have.

THOMAS SINKS, PhD
Acting Director
National Center for Environmental Health/Agency for Toxic Substances and Disease Registry
Centers for Disease Control and Prevention
Department of Health and Human Services

Dr. Thomas Sinks is the Acting Director of the National Center for Environmental Health/Agency for Toxic Substances and Disease Registry (NCEH/ATSDR) at the Centers for Disease Control and Prevention (CDC).

Dr. Sinks has held several leadership roles at CDC. As the Acting Deputy Director for Program for NCEH/ATSDR, Dr. Sinks was the principal deputy on scientific and program issues for the agency, and he assisted the director in the agencies' day-to-day operations and long term strategies. He became Associate Director for Science (ADS), NCEH in 1995 and was named the lead scientist for both NCEH and ATSDR in October 2003. As the ADS, his responsibilities included assuring the quality, integrity, and development of science throughout NCEH/ATSDR. He was the Acting Associate Director for Chemical and Radiological Terrorism Preparedness and Emergency Response from February through October 2003. Dr. Sinks helped establish and coordinate CDC's preparedness and response activities relating to chemical or radiological emergencies and natural disasters. Dr. Sinks served as the Acting Director, Division of Birth Defects, Child Development, Disability and Health from October 1999 until November 2000 when it became the National Center for Birth Defects and Developmental Disabilities. In 1997, Dr. Sinks served as Acting Chief, Air Pollution and Respiratory Health. In 1991-1994, Dr. Sinks was the Chief, Health Studies Branch, conducting epidemiologic investigations of hypervitaminosis D in Massachusetts, ackee poisoning in Jamaica, optic neuropathy in Cuba, heat wave-related deaths in Philadelphia, and the 1992 bombing of the World Trade Center.

Dr. Sinks began his CDC career in 1985 as an Epidemic Intelligence Service Officer assigned to the National Institute for Occupational Safety and Health (NIOSH). He remained at NIOSH until 1991 and was involved in investigations of respiratory disease among Hawaiian sugarcane workers and the causes of mortality of electric capacitor builders exposed to PCBs.

Dr. Sinks received his Bachelor of Science degree from the Tulane University, New Orleans, La., in 1973. He received his Masters of Science and Doctor of Philosophy degrees in 1982 and 1985 respectively from the Ohio State University. He is married to Dr. Kelley Scanlon, a nutritionist and epidemiologist at CDC. They have 3 children, Nicholas (age 11), Hannah (age 9), and Sarah Halle (age 2)