Proving Cause - similar to the issue with vaccines

[Guest guest]

Proving Cause - similar to the issue with vaccines - especially when it

comes to taking responsibility - and even more so for vaccines as it

involves current vaccines in use and lots of money.

Sheri

http://www.nytimes.com/2006/10/24/nyregion/24toxic.html?_r=1 & th= & oref=slogin

& emc=th & pagewanted=print

October 24, 2006

Medical Views of 9/11’s Dust Show Big Gaps

By ANTHONY DePALMA

In 2004, R. Feinberg, special master of the federal Sept. 11 Victim

Compensation Fund, awarded $2.6 million to the family of a downtown office

worker who died from a rare lung disease five months after fleeing from the

dust cloud released when the twin towers fell. That decision made the

worker, Felicia Dunn-, a 42-year-old lawyer, the first official

fatality of the dust, and one of only two deaths to be formally linked to

the toxic air at ground zero.

The New York City medical examiner’s office, however, has refused to put

her on its official list of 9/11 victims, saying that by its standards

there was insufficient medical evidence to link her death to the dust.

Mrs. Dunn-’s case shows how difficult it can be to prove a causal

connection with any scientific certainty — and how even government

agencies can disagree. With thousands of people now seeking compensation

and treatment for dust exposure, the debate about the relationship between

the toxic particles and disease will be a central issue in the flood of

Sept. 11-related lawsuits. Health experts are starting to document the

connections, but any firm conclusion is still years away.

Most of the suits involve workers who spent weeks and months on the pile at

ground zero and say the city and other agencies failed to protect them from

the toxic dust. Others involve residents who say they were made sick by

dust that settled in their homes. Mrs. Dunn- was among those downtown

office workers caught in the initial fallout.

The question that arises in all these cases is straightforward: Can a link

between the dust and disease be proved with scientific certainty? The

answer is anything but simple.

“Certainty is a word we always dance around,†said ph Graziano,

associate dean for research at the Mailman School of Public Health at

Columbia University. For him, searching for the cause of disease is like

developing film. “At first you see a faint image of what the real picture

is,†Dr. Graziano said, “and then, over time, you see it with much more

clarity. In these relatively early times, the image is still faint.â€

It can take decades to approach any degree of certainty. For instance, only

after years of observation did doctors agree that there was a strong link

between asbestos and diseases like asbestosis and mesothelioma.

In legal cases, “a reasonable degree of medical certainty†is

considered the gold standard in making a causal connection. Last week, a

federal judge cleared the way for thousands of workers’ lawsuits to go to

trial. When the cases are heard, any proof that does not meet that legal

standard is likely to be challenged.

But outside the courtroom, scientists say, even a less rigorous link could

be sufficient to warrant expanding the range of illnesses covered by

treatment programs, and to serve as the basis for issuing cautions to

people in high-risk groups. When the health effects are too new or the

evidence is too vague for a strong link, lesser indicators like the

concurrence of different studies have to be relied on.

For example, nearly every ground zero study shows that workers and

residents exposed to the dust in the hours after the collapse have suffered

the worst health problems. The consistency in that data has helped doctors

monitor and treat people since Sept. 11.

And it may also help explain why Mrs. Dunn-, a dynamic civil rights

lawyer with the United States Department of Education, became so sick so

quickly. As she was swallowed by a whirling dust plume filled with

asbestos, benzene, dioxin and other hazards when the first tower fell, all

she could do was cover her nose and mouth as she fled from her office one

block north of the World Trade Center.

It was night by the time she got home to Staten Island. “She was in a

state of shock,†her husband, ph , recalled. Her clothes were

still dusty, but he didn’t pay much attention. “I was just so happy to

see her,†he said.

For the next few months, life returned to normal, until Mrs. Dunn-

developed a cough. In January 2002, the cough grew worse. On Feb. 10, she

suddenly stopped breathing and died.

Mr. , 54, an assistant manager at a Brooklyn pharmacy, was stunned.

Then, when he received the official death certificate months later, he was

shocked to see an unfamiliar word — sarcoidosis.

“Even though I was in the medical field, I had never heard of it,†he

said.

After reading several medical reports on sarcoidosis — including one by

Dr. J. Prezant, deputy chief medical officer of the New York Fire

Department — Mr. and his lawyer, H. , wondered if

Mrs. Dunn-’s mysterious death could be linked to 9/11 dust because

sarcoidosis, which produces microscopic lumps called granulomas, on vital

organs, is often associated with exposure to environmental hazards.

They took the case to Mr. Feinberg and the victim compensation fund, which

gave $7 billion to the families of those killed or injured on 9/11.

Mr. Feinberg initially expressed doubts about the claim and demanded to see

definitive medical evidence linking Mrs. Dunn-’s sarcoidosis to the

dust.

Dr. Prezant, who declined to be interviewed for this article, was one of

two experts who testified at a hearing conducted by Mr. Feinberg. In the

first four years after 9/11, he found 20 cases of sarcoidosis in the Fire

Department, a rate of 80 per 100,000 in the first year (with treatment, all

are now stable), compared with a national rate of fewer than 6 per 100,000,

according to the American Thoracic Society.

The other expert was Dr. Alan M. Fein, a clinical professor of medicine at

the New York University School of Medicine. He, too, was skeptical at

first, but he said he changed his mind after reviewing Mrs. Dunn-’s

medical record, including the autopsy report. “I’m comfortable saying

her death was caused by exposure to the dust,†Dr. Fein said in an

interview.

In March 2004, Mr. Feinberg agreed, making Mrs. Dunn-’s death the

only dust-related fatality recognized by the fund. Only one other death has

been formally linked to the dust: In April, a New Jersey coroner determined

that Zadroga, 34, a New York City police detective, had died of a

disease similar to sarcoidosis, also caused by his exposure to ground zero

dust.

Mr. welcomed the settlement from the victim compensation fund, and

believes that his wife was a 9/11 victim as surely as if she had died in

the towers. He sent Mr. Feinberg’s decision to the city’s chief medical

examiner, Dr. S. Hirsch, and asked that his wife be put on the

official list so that her name could be read on Sept. 11. Dr. Hirsch

refused, a spokeswoman said, because the available evidence did not prove

the connection “with a reasonable degree of medical certaintyâ€â€” the

highest medical standard generally used in legal cases.

Mr. Feinberg’s decision had been based on a different standard: a

preponderance of medical evidence.

That was proof enough for the Staten Island Memorial Commission, which has

engraved Mrs. Dunn-’s name on the bone-white memorial on the

island’s north shore.

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Sheri Nakken, R.N., MA, Hahnemannian Homeopath

Vaccination Information & Choice Network, Nevada City CA & Wales UK

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