Connecting the Connecting the DotsDots

in Toms River and in Toms River and BeyondBeyond

Dan FaginDan FaginNew York UniversityNew York University

danfagin.comdanfagin.com

Ca•tas•tro•phe [kuh-Ca•tas•tro•phe [kuh-tas-truh-fee]: 1. A tas-truh-fee]: 1. A health effect so large health effect so large even an even an epidemiological study epidemiological study can detect it.can detect it.

-- D. Ozonoff-- D. Ozonoff

Toms RiverToms River

99

ParacelsParacelsusus

Toms RiverToms River

1313

Ramazzini

1414

1515

William FarrJohn Snow

PerkinPerkin

1616

Hueper

Yamagiwa

Toms RiverToms River

1717

Doll

“Toms River had a moderately elevated SIR for all cancers combined (49% higher) and leukemia (80% higher). However, neither of these SIRs were statistically significant. Brain and CNS cancer was more than three times higher than expected for children under 20. For Toms River children under five, brain and CNS cancer incidence was significantly elevated, over seven times higher than expected. All SIRs calculated for Dover Township were higher than expected. Brain and CNS cancer in children under five was more than two and one-half times higher than expected, though not statistically significant…”

“Because of the small number of cases included in this analysis, it is not possible to conduct studies to determine possible causes at the municipality or even county level.”

-- Michael Barry, NJ State Dept. of Health

8/31/95 unreleased letter

Children prenatally exposed to Parkway Water 1982-96,

diagnosed with leukemia or CNS Cancers before age 20:

Girls Girls prenatally exposed to Parkway prenatally exposed to Parkway Water Water 19841984-96, -96,

diagnosed with diagnosed with leukemia only leukemia only before before age 20:age 20:

Girls prenatally exposed to Parkway Girls prenatally exposed to Parkway Water 1984-96, Water 1984-96,

diagnosed with leukemia diagnosed with leukemia before age 5before age 5::

Girls prenatally exposed to Parkway Water 1984-96, diagnosed with leukemia before age 5 (birth

records study):

“Although no associations were detected in analyses of the overall study population, a statistically significant association and consistency in multiple measures of association were seen between prenatal exposure to time-specific Parkway well field water (1982-1996) and leukemia in female children of all ages.”

“Although no associations were detected in analyses of the overall study population, a consistent elevation in the odds ratios and an apparent dose response effect was seen in both the Interview and Birth Records Studies between prenatal exposure to Ciba-Geigy ambient air and leukemia in female children diagnosed prior to age five.”

Toms RiverToms River 2727

What Now?• Make peace with uncertainty in public health; epidemiology works.

• Capitalize on Big Data: $80 billion vs. $8 billion.

• Robust oversight, adequately funded. No more hollow agencies.

• Much more independent science, especially in regulatory decision-making.

• No more empty slogans and reflexive combat. Engage with evidence, acknowledge uncertainty (again!), recognize tradeoffs.

• Important information cannot be contained in a digital world.

• As reach, influence of professional media declines, burden is on stakeholders to provide context and be transparent about agendas. Shirk it at your peril.