Oak Ridge Reservation: Public Health Assessment Work Group

Public Health Assessment Work Group

September 17, 2001 - Meeting Minutes

Agenda

1. Approve minutes of PHA WG meetings on 7/19 (addenda), 8/6, 8/20, 8/28 (see attachments) - Bill Pardue
   
2. View videotape of Joseph Mangano on his report "Cancer martality near Oak Ridge, Tennessee"
   
3. Review/approve draft recommendation on the Mangano report for presentation to ORRHES - Bill Pardue
   
4. Discuss draft recommendation on need for secretarial support from ATSDR for ORRHES activities - Bill Pardue
   
5. Brief introduction on ATSDR approach to screening for contaminants of concern - Jack Hanley, Karl Markiewicz
   
6. 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.