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HRG. 110–197 LONG-TERM HEALTH IMPACTS FROM SEPTEMBER 11: A REVIEW OF TREATMENT, DIAGNOSIS, AND MONITORING EFFORTS HEARING OF THE COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS UNITED STATES SENATE ONE HUNDRED TENTH CONGRESS FIRST SESSION ON EXAMINING A REVIEW OF TREATMENT, DIAGNOSIS, AND MONITORING EFFORTS, FOCUSING ON THE LONG-TERM HEALTH IMPACTS FROM SEPTEMBER 11 MARCH 21, 2007 Printed for the use of the Committee on Health, Education, Labor, and Pensions ( Available via the World Wide Web: http://www.gpoaccess.gov/congress/senate U.S. GOVERNMENT PRINTING OFFICE 34–458 PDF WASHINGTON : 2008 For sale by the Superintendent of Documents, U.S. Government Printing Office Internet: bookstore.gpo.gov Phone: toll free (866) 512–1800; DC area (202) 512–1800 Fax: (202) 512–2104 Mail: Stop IDCC, Washington, DC 20402–0001 VerDate Aug 31 2005 16:08 Jul 30, 2008 Jkt 000000 PO 00000 Frm 00001 Fmt 5011 Sfmt 5011 S:\DOCS\34458.TXT SLABOR1 PsN: DENISE COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS EDWARD M. KENNEDY, Massachusetts, Chairman CHRISTOPHER J. DODD, Connecticut MICHAEL B. ENZI, Wyoming, TOM HARKIN, Iowa JUDD GREGG, New Hampshire BARBARA A. MIKULSKI, Maryland LAMAR ALEXANDER, Tennessee JEFF BINGAMAN, New Mexico RICHARD BURR, North Carolina PATTY MURRAY, Washington JOHNNY ISAKSON, Georgia JACK REED, Rhode Island LISA MURKOWSKI, Alaska HILLARY RODHAM CLINTON, New York ORRIN G. HATCH, Utah BARACK OBAMA, Illinois PAT ROBERTS, Kansas BERNARD SANDERS (I), Vermont WAYNE ALLARD, Colorado SHERROD BROWN, Ohio TOM COBURN, M.D., Oklahoma J. MICHAEL MYERS, Staff Director and Chief Counsel KATHERINE BRUNETT MCGUIRE, Minority Staff Director (II) VerDate Aug 31 2005 16:08 Jul 30, 2008 Jkt 000000 PO 00000 Frm 00002 Fmt 5904 Sfmt 5904 S:\DOCS\34458.TXT SLABOR1 PsN: DENISE CONTENTS STATEMENTS WEDNESDAY, MARCH 21, 2007 Page Kennedy, Hon. Edward M., Chairman, Committee on Health, Education, Labor, and Pensions, opening statement ........................................................... 1 Prepared statement .......................................................................................... 2 Enzi, Hon. Michael B., a U.S. Senator from the State of Wyoming, opening statement .............................................................................................................. 3 Clinton, Hon. Hillary Rodham, a U.S. Senator from the State of New York ..... 5 Prepared statement .......................................................................................... 6 Schumer, Hon. Charles E., a U.S. Senator from the State of New York ............ 9 Bloomberg, Hon. Michael R., Mayor, New York, NY; accompanied by Ed Skyler, Deputy Mayor, New York, NY ............................................................... 11 Coburn, M.D., Hon. Tom, a U.S. Senator from the State of Oklahoma .............. 20 Brown, Hon. Sherrod, a U.S. Senator from the State of Ohio ............................. 22 Nadler, Hon. Jerry, a U.S. Representative from the State of New York ............ 24 Herbert, Robin, M.D., Co-Director, The World Trade Center Worker and Volunteer Medical Screening Program, New York, NY .................................... 26 Prepared statement .......................................................................................... 30 Kelly, Kerry, M.D., Chief Medical Officer, New York Fire Department, New York, NY ............................................................................................................... 34 Prepared statement .......................................................................................... 37 Reibman, Joan, M.D., Director, Bellevue Hospital World Trade Center Envi- ronmental Health Center, New York, NY .......................................................... 64 Prepared statement .......................................................................................... 67 Melius, James, M.D., Ph.D., Chair, Advisory Board of the World Trade Center Medical Monitoring and Treatment Program, Albany, NY .............................. 70 Prepared statement .......................................................................................... 72 Stellman, Jeanne Mager, Ph.D., Mailman School of Public Health, Columbia University, New York, NY ................................................................................... 76 Prepared statement .......................................................................................... 78 Endean, Jeffrey L., Ph.D., Ground Zero Volunteer and Former Division Com- mander, Morris County New Jersey Sheriff ’s Office, Succasunna, NJ ........... 81 Prepared statement .......................................................................................... 83 (III) VerDate Aug 31 2005 16:08 Jul 30, 2008 Jkt 000000 PO 00000 Frm 00003 Fmt 5904 Sfmt 5904 S:\DOCS\34458.TXT SLABOR1 PsN: DENISE IV Page ADDITIONAL MATERIAL Statements, articles, publications, letters, etc.: Alison S. Geyh, Ph.D., Assistant Professor of Environmental Health Engi- neering, John Hopkins Bloomberg School of Public Health (JHSPH) ...... 94 Eli J. Kleinman, M.D., Assistant Professor of Medicine and Attending Hematologist, Albert Einstein College of Medicine and Attending Physi- cian of Mt. Sinai, New York City, NY ......................................................... 97 Unions, Organizations, and Workers Supplemental Materials .................... 101 Resident Supplemental Materials ................................................................... 134 Mt. Sinai Supplement Material ....................................................................... 161 Response by Robin Herbert, M.D. to questions of: Senator Kennedy ....................................................................................... 162 Senator Enzi .............................................................................................. 163 Senator Clinton ......................................................................................... 166 Response by James Melius, M.D., Ph.D. to questions of: Senator Kennedy ....................................................................................... 167 Senator Enzi .............................................................................................. 168 Senator Clinton ......................................................................................... 170 Questions of Senators Kennedy, Enzi, and Clinton to Hon. Michael R. Bloomberg ...................................................................................................... 171 Questions of Senators Enzi and Clinton to Kerry Kelly, M.D. ..................... 172 Questions of Senator Enzi to Joan Reibman, M.D. and Jeanne Stellman, Ph.D. .............................................................................................................. 173 VerDate Aug 31 2005 16:08 Jul 30, 2008 Jkt 000000 PO 00000 Frm 00004 Fmt 5904 Sfmt 5904 S:\DOCS\34458.TXT SLABOR1 PsN: DENISE LONG-TERM HEALTH IMPACTS FROM SEPTEMBER 11: A REVIEW OF TREATMENT, DIAGNOSIS, AND MONITORING EFFORTS WEDNESDAY, MARCH 21, 2007 U.S. SENATE, COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS, Washington, DC. The committee met, pursuant to notice, at 10:05 a.m. in Room SH–216, Hart Senate Office Building, Hon. Edward Kennedy, chairman of the committee, presiding. Present: Senators Kennedy, Clinton, Brown, Enzi, and Coburn. Also present: Senator Schumer OPENING STATEMENT OF SENATOR KENNEDY The CHAIRMAN. We’ll come to order, if we would, please. We’ll come to order and thank all of our members here. I’m particularly appreciative of Senator Enzi, who is our Ranking Member here this morning and Senator Clinton, who has been the—as with Senator Schumer, tireless advocates for those that have been lost and those that have suffered under the egregious assaults and attack on New York and we’re incredibly appreciative and grateful for the pres- ence of the Mayor, who will be presented by our friend and col- league, Senator Schumer, in just a moment. I commend the Ranking Member, my colleague and friend, Sen- ator Enzi, for his contributions to this hearing. I also commend my colleague, Senator Clinton, for her commitment to seeing that this hearing would happen and I welcome our colleague, Senator Schu- mer, who will introduce the Mayor of New York in just a moment. We’re here today to consider the impacts of the events of 9/11 on the lives and health of the brave men and women who responded to the call for help that day as the heroes of 9/11: the police offi- cers, the emergency medical technicians, the construction workers, the firefighters, the sanitation workers and numerous other profes- sions. They were our clean up and our recovery effort, working at Ground Zero, at the Fresh Kills Landfill on Staten Island, month after month after month in the wake of 9/11. They are the school children who returned to their classrooms and the residents who returned to their apartments in Lower Manhattan in the days and weeks after the collapse of the towers. They are the New Yorkers, struggling to reclaim their lives after that horrendous attack. These rescue, recovery and clean-up workers were exposed to mul- tiple toxins and pollutants from PCBs and dioxins to pulverized concrete and highly metallic, microscopic shards of glass. (1) VerDate Aug 31 2005 16:08 Jul 30, 2008 Jkt 000000 PO 00000 Frm 00005 Fmt 6633 Sfmt 6633 S:\DOCS\34458.TXT SLABOR1 PsN: DENISE 2 They inhaled these substances into their lungs and ingested them into their gastrointestinal systems. Hundreds of thousands of them have