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WALL STREET JOURNAL, April 14, 1981 Copied for D . L . Engle D. H. Glenn Medical Sleuths Fear of Toxic Materials Creates More Demand For Epidemiologists Dow Chemical Study Seeks Link Between 24 Deaths And Work at Texas Plant A Tedious, Frustrating Trail By Georgette Jasen j Staff Hvporutt of Tmk Wall Strut .'Journal It reads like R detective story. Twenty-four men (rom a small area on the Texas Gulf Coast are mysteriously dead of a rare disease, brain cancer. Investiga tors have silted through thousands of pages of evidence - and talked with people who might know something about the case, but so far they don't know what caused the dis ease. One theory holds that the deaths are related to the men's work: All 24 were em ployed at a Dow Chemical Co. plant in Free port, The detectives are epidemiologists, medi cal specialists who study the causes of dis ease in people. A typical team might include physicians, some of whom have doctorates In public health; non-physicians with gradu- ate degrees in. public health; nasologtsts (specialists In classifying diseases): statisti cians, and derkx - Epidemiologists are In demand more than ever these days. As the public becomes more aware af health problems caused by toxic substances, pressure has Increased on corporations and'government agencies to show that products and working conditions are safe. -; A Household Word? Dow, for example, has more than a (token people working In epidemiology; In the lata I960* it had one. Denise deMan. a Beverly Hills-based recruiter for healthsdences Jobs, says requests tor epidemiologists have Increased at least fourfold in the past three yean. "Now people can spell It," she says. Today epMemtotogfsts are Involved in dozens of major Investigations. Both govern ment and corporate teams are working on the Dow case. Union Carbide Gorp- workers in Texas are the subject of a similar brain- cancer study. Monsanto Co. recently studied its employes who may have been exposed to dioxin, a contaminant found In some herbi cides. ('-iKi'V the chemical Industry, epidemiol- ogicr.: 'n-ihrds are being used to seek a link between tampons and toxic shock syndrome. "There will be even more studies." predicts Ralph R. Cook. Dow's chief epidemiologist. "The public is asking more-sophisticated questhms." Providing the answers is costly. A physi cian with a doctorate in public health can earn about 37U.OOO in industry. Union Car bide says its brain-cancer study will cost S25u,W*i. Dow spends more than $20 million a year for research on health, safety and the environment. Too Costly for Small Companies And the outlays are rising, to the point at which some smaller chemical companies may be hard pressed. "There will be tre mendous distortions in the chemical indus try." says Elcyl Blair. Dow's vice president for health and environmental sciences. "Small companies that don't have the re sources will be shut out." The case of the 24 Dow workers in Texas illustrates how much time, effort and money are consumed in epidemiological studies, and how the inherent imprecision can lead two groups to draw different conclusions in a single situation. It began in November 19TS, when a , worker at Union Carbide's plant not far , from Dow's was diagnosed as having brain i cancer. He knew two other workers at the j plant who had died of brain tumors, and he called the Occupational Safety and Health Administration's regional office in Clear Lake City. Texas, wondering if the disease could be related to working at the plant. OSHA's regional office quickly turned up two other brain-cancer deaths of Carbide workers, and later the total of cases discov ered was IS--Ironically not including the worker who approached OSHA. since bis cancer began in another part of his body. OSHA and Union Carbide are Jointly investi gating those cases. But while searching tor brain-cancer deaths among Carbide workers. OSHA in vestigators discovered the similar deaths among workers at the Dow Chemical plant in the same area. Twice the Risk OSHA compared the ratio of brain-cancer deaths among Dow workers with the ratio of such deaths in Brazoria County, where the Dow plant is located. It concluded that Dow workers faced twice as much risk of con tracting the disease as other people. Dow. which has a larger and more estab lished. epidemiology staff than Carbide, quickly did Its. own study. In two weeks it j checked the work histories and concluded that there wasn't any Unk between the chemicals they worked with and their dis ease. It also said that when adjusted tor the age of the workers, the number of deaths in the plant wasn't much out of line with na tional avenges. It could be years before the issue Is re solved. Based on the preliminary data, gov ernment researchers remain convinced that the brain cancers are work related; com pany officials still think they aren'L OSHA and Dow agreed to conduct a more thorough investigation, which has been run ning tor about a year; data-gathering should be completed by this summer. About 2,000 employes-a random sample of the more than 40,000 men (women don't contract the disease nearly as ofteni who have worked at the Dow plant since It opened In 1940-are being studied. The two teams will share data but write separate reports. It's by no means certain they will agree. There are indications that the two sides elenv Turn f, pngr t'tiliimm I \ UCC 097239 WALL STREET JOURNAL, April 14,1981 Page 2, .3 myj-i TTP^Tir(mi yiyuiirmeiwwrea-gg^sa Medical Sleuths: Demand Is Increasing For Epidemiologists Continued From First Page don't trust each other. "Some government j studios are fishing expeditions." says Perry Ccltnng. a Dow vice president. "They find I anything they can catch." On the government side, Victor Alexan der. an OSHA physician, says. "We encour age companies to do all the epidemiology they like. We also have an obligation to do the best job we can. We might want to look into things they don't." Questioned directly, however, both deny there's any mistrust, just legitimate differences in methodology. "K depends on how you slice up the Infor mation," says J. William Lloyd, an OSHA epidemiologist. Epidemiology Isn't an exact science. Peo ple. unlike laboratory animals, are exposed to many substances every day, and It's often difficult to isolate the harmful ones. "It's ex asperating." says Irving J. Selikoff, a pro fessor of environmental medicine at Mount Sinai School of Medicine In New York. "There arc no instant answers." And a study of cancer deaths Is always difficult. To begin with, there's still a lot to learn about the disease. Although It's widely agreed that environmental (actors contrib ute to most cancers, there are dearly other causes, too: Not all smokers contract lung cancer, for example. Current research seems to Indicate that several (actors work ing together may sharply Increase the risk. For example, asbestos workers who smoke develop cancer at a far higher rate than either smokers who don't work with asbes tos or asbestos workers who don't smoke. Because cancer sometimes takes a to 30 years to develop, it's nearly Impossible to know all the substances the victims were ex posed to. As Dow's Dr. Cook says, "The ideal thing would be to Implant a monitor in the right buttock at birth." | Brain cancer presents still further preb- I loins. TVc.iuse it is rare-.in psiunnied four i ;i year per Kji iihii |n|mluncii - investi gators have few cases to work with. A single statistical error can affect results. What's more, brain cancer is frequently misdi agnosed. All of this means that a study like Dow's takes a long time, even though it Involves only a 5% sample. And. unlike a criminal In vestigation, the work Isn't dramatic or glamorous. Dr. Cook says. "Things come In like the tide. It's dealing with paper." Even the simplest tasks are frustrating. Personnel records at Dow are filed alpha betically. It would be easier for epidemiolo gists If they were arranged by dale of em ployment or by department-that way work ers who were hired at a particular time or who worked In a particular department could be reviewed separately. When the study started, there were no indexes. Many records are on microfiche, requiring re searchers to spend hours reading enlarge ments on machines. It takes a major effort just to determine how many former workers have died and the causes. Investigators say they now know whether nearly all of the sample Is alive or dead; It wasn't easy to find out even that. Reviewing personnel records for date and cause of death and death certificates from three counties surrounding the plant was Just the beginning. A list of names was sent to the Social Se curity Administration in Washington to find out whether a death claim had been filed or where retirement benefits were being sent. The names of those stilt missing were sent to the Texas motor-vehicles bureau. Govern ment agencies can ask the Internal Revenue Service for a last known address, and there are Mgh-schoot and college alumni records and checks of local telephone hooka. "It's shoe-leather epidemiology." says Dr. Cook. Investigators may never know what workers were breathing and handling in the plant. Before the Occupational Safety and Health Act was passed In 1970, few compa nies measured or analysed chemicals In the workplace. Protective equipment. If It was available, wasn't always worn. "The compa nies don't know, nobody knows." says Mount Sinai's Dr. Selikoff. "Our Inadequacies of the past are coming home to roost" Even work histories don't always help. Building names and numbers have changed. as have manufacturing processes and Job ti tles. The Dow plant is one of the largest in the world. Hundreds of chemicals are made there, and others are used In the manufac turing process. "Even if you knew someone worked In an ethylene plant tor 10 years, you mny not be able to tell It he was an op erator In an air-conditioned control room or a production person sloshing around in the stuff," says Gordon Reeve, an epidemiolo gist with the National Institute of Occupa tional Safety and Health. Workers did slosh around In chemicals In the early days of the plant. "Back In the 1930s, you went In with your hands and washed tools, clothes and parts in carbon tetrachloride," recalls O.D, Kenemore, pres ident of the Freeport Metal Trades Council, an association of unions, who worked as a pipefitter In the plant "They wouldn't let a drop of It on the floor now." Carbon tetra chloride. once a commonly used cleaning fluid, has been shown to cause cancer In laboratory animals. Working conditions have changed so much in fact, that epidemiologists concede that even if there was a problem years ago, it may no longer exist They continue to be concerned, however, because so many work ers still could face health problems caused by previous exposures, or a cancer-causing substance could remain. "The real potential danger is that there's a chemical In the plant that no one sus pects." says Dr. Alexander, the OSHA epi demiologist "We won't see the benefits of Improved controls until the turn of the cen tury-" 'SPECIALISTS IN OCEAN AND AIR CARGO INSURANCE Unmatched Service Lowest Possible Ratos Fast Claim Settlement Representing Uia moat rallabla old Una companies Internationally REKERDRESAGENCY 1000 Cotton Exchange Building ,,,J(214| 748-6756 Dat'd* 75201 ,- UCC 097240