INPUT FROM THE PUBLIC
THE SUBCOMMITTEE HELD 3 PUBLIC MEETINGS as part of its evaluation of the health impacts from the release of zinc cadmium sulfide (ZnCdS) by the Army. The meetings were held in Minneapolis, MN, on May 25, 1995; Fort Wayne, IN, on July 31, 1995; and Corpus Christi, TX, on October 18, 1995. Their purpose was to gather information and learn about public concerns related to the release of ZnCdS. Minneapolis and Fort Wayne were chosen because of heightened concern about possible health effects and the presence of community groups that were gathering information and pressing for answers. Corpus Christi was chosen because it was a coastal city and the subcommittee wanted to determine whether anything more could be learned from the site of an aerial coastal spray. In addition, the Army had completed risk assessments for each of the 3 communities.
Each meeting was held at a location that was easily accessible to the public. Before the meeting, National Research Council staff sent press releases to all the local media and to national media that cover Research Council activities in the area and advertised the meeting in local newspapers. Mayors, members of Congress representing the district, U.S. senators of the state, and other elected officers were informed of the meetings
so that they could inform their constituents. People were encouraged to register to speak by calling or writing to Kulbir Bakshi, project director for the subcommittee. The subcommittee was available before and after the meeting to talk to the media.
Each meeting began with a presentation about the subcommittee, which included background on the Research Council and the National Academy of Sciences, how the subcommittee was formed, the tasks assigned to it, a brief description of the work already completed by it, and the introduction of its members.
The public meetings in Minneapolis and Fort Wayne each lasted a full day. Of the 88 people who signed the registration sheets in Minneapolis, 24 presented formal comments. Of the 162 who signed the registration sheets in Fort Wayne, 33 spoke. The meeting in Corpus Christi lasted a half-day; of the 23 who signed up, 11 spoke. Appendix E contains the agendas for the public meetings. After each presentation, the subcommittee members were able to ask questions to clarify comments and gain additional information. At the conclusion of the comment sessions, open-microphone sessions provided an opportunity for an informal exchange of information and points of view among participants, members of the audience, and subcommittee members. The proceedings of the meetings were recorded and transcribed. Fact sheets provided at the meetings included information about how to obtain transcripts.
NATURE OF COMMENTS
The public meetings were both emotional and informative. The many questions and issues raised were in three general categories: concern about possible health effects of exposure to ZnCdS, outrage about being exposed to a chemical by the government without being informed, and requests for information about the spraying activities—how, how much, when, where, and why.
Many people expressed pride in being American and having served their country but difficulty in believing that their government could have carried out the spraying activities without disclosing them to the public. People expressed concern about identifying and holding accountable those re-
sponsible for the testing and about ensuring that testing without the informed consent of the subjects would never be repeated. Those concerns are related to trust in the government. Several people who presented comments clearly stated that an open, thorough examination of the issues, beginning with the work of this subcommittee and its open-meeting process, could help to restore confidence in the government.
It was evident that many speakers in the three communities had put a great deal of effort into preparing their comments. Some had compiled and documented detailed information about the health status of those who were in the area during the release of ZnCdS or had researched other aspects of community health. The information presented ranged from discussion of individual or family health histories to detailed maps with markers showing health problems in areas that were sprayed.
In Fort Wayne, one family described how the mother had developed malignant melanoma and had been sent to Minneapolis for special treatment. Since becoming aware of the ZnCdS spraying, they had discovered that between 1973 and 1976, 17 other people from Fort Wayne had been sent to the same clinic in Minneapolis for treatment of melanoma. One of the sisters in the family had put together a map showing the homes of 70 persons who either had died from cancer or had had cancer diagnosed, the location of ZnCdS sampling stations, and the general pattern of the fallout of dispersed ZnCdS.
Several speakers presented lists of people with health problems who lived in areas where ZnCdS had been released. In Corpus Christi, for example, a woman presented a list of 80 people, all with cancer, who lived in the town of Taft, 18 miles north of Corpus Christi, 90% of them lived in a 12-block area of the town. The cancers in the town included cancers of the liver, brain, breast, colon, and prostate. The speaker was hoping for insight into what could have caused this group of cancers.
Some of the individual comments were very personal and emotional. For example, a mother in Minneapolis who lived in the area where ZnCdS had been released discussed the physical problems of her daughter who died at the age of 46 after a long history of health problems, including irregular menstrual cycles, repeated growth of very large cysts, and a collapsed lung.
Many people indicated that they did not know what caused their health
problem, nor did they assert that ZnCdS exposure was the cause, but they wanted the subcommittee to have whatever information might help to answer the concerns raised.
A common theme throughout the testimony was the frustration that answers were not available as to why people had their health problems. People described having rare illnesses and seeing several experts to look for causes of their illnesses. Many wondered whether ZnCdS, which they understood to be carcinogenic and had been released in an area where they lived, was in some way responsible for their health condition.
Many questions were raised about individual health problems at the public meetings and in written comments submitted to the subcommittee. In general, the questions were divided into four categories: about whether exposure to ZnCdS could have caused the problems, about the unique sensitivity of children and whether children would be more sensitive to exposure to ZnCdS than adults, about future health problems both for the participants and for their children and their children's children, and about cumulative health effects. The subcommittee's report for the general public addresses the most commonly asked questions (NRC 1997).
The comments and testimony at the public meetings made clear a serious need for public-health information in the communities that was not being addressed. People had many questions but did not know where to go for health-care information. People reported that inquiries to local, state, and federal health agencies had provided little information.
Many of the comments about possible effects on human health and the environment have been useful in the subcommittee's analysis. For example, the community concerns about a wide array of health effects showed the subcommittee that it had to consider many possible health effects and not focus only on cancer. Comments also emphasized that the subcommittee's analysis should consider particularly sensitive (susceptible) populations (such as children and the elderly), variations in populations, and age distribution. Descriptions of conditions in the communities at the time of testing increased the subcommittee's insight into possible community-specific exposure pathways, such as the use of surface-water reservoirs to supply drinking water, and variations in life styles. Some, especially representatives of the Leech Lake Band of Chippewa in Minnesota, emphasized the need to consider effects on the environment, not just those
on human health. However, the effect of ZnCdS on the environment is beyond the scope of the subcommittee's task.
Some of the speakers remembered the testing, and a few had helped to carry it out. They were able to provide insight into how the material was dispersed and how the sampling was conducted and they provided their recollections of what happened in the communities during the tests. Some people who were involved in the conduct of the ZnCdS dispersion tests did not report adverse health effects associated with the tests.
SPECIFIC HEALTH PROBLEMS
The types of health effects discussed most often by concerned residents differed among the three communities. For example, reproductive problems were more commonly reported at the public meeting in Minneapolis than elsewhere, whereas cancer was mentioned most often in Fort Wayne and Corpus Christi.
Overall, the most common reports presented at the public meetings were on cancer. All three communities reported concern about apparent cancer clusters, although the type of cancer varied. In Minneapolis, for example, an organized community group called Children of the Fifties reported cancer and other health problems in children who attended the Clinton Elementary School. ZnCdS had been released from the roof of the school and from nearby mobile vehicles. The group had identified 350 of the 800 students who attended the school and found that many had already died, a large number from cancer. The group is considered in more detail in Chapter 7. In Fort Wayne, residents described a number of cases of malignant melanoma and breast cancer. In particular, some specific cases of breast cancer in young women were noted by citizens and a local physician. The cancers reported at the public meetings included cancers of the prostate, thyroid, salivary glands, esophagus, breast, bladder, colon, kidney, uterus, ovaries, blood cells, and brain. Other health problems reported in the three communities included difficulty in getting pregnant; miscarriages and other reproductive disorders, including enlarged uterus and female infertility; respiratory problems, including pneumonia, bronchitis, and asthma; thyroid disorders; swollen glands;
joint pain; and skin problems. Other disease categories identified were congenital disorders, including mental retardation, learning disorders, Down's syndrome, and liver malformations. Immunologic diseases included disorders of the thyroid gland and skin and asthma. Infections of lungs and ears were also reported.
Degenerative diseases of the central nervous system, such as Parkinson's disease, were reported, as were other degenerative and metabolic disorders such as atherosclerosis and heart problems, arthritis, diabetes mellitus, diabetes insipidus, and osteoporosis.
A number of nonspecific complaints that do not fit into any disease category were noted, such as the development of cysts, high blood pressure, dizzy spells, coughing, swollen glands, joint swelling, weight gain, fatigue, and nosebleeds.
The subcommittee has drawn valuable information and guidance from the presentations made at the public meetings and other comments submitted by the public. Members of the public who presented comments to the subcommittee were concerned about a wide array of health effects, including cancer and reproductive effects, and about whether these effects could have been caused by exposure to ZnCdS. They were also concerned about the possibility of increased risk to sensitive populations, such as children and the elderly. Moreover, people were outraged at being exposed to chemicals by the government without their knowledge or consent. The subcommittee did not address ethical and other social issues about the Army's dispersion tests; these questions are important, and the Army must develop a mechanism for addressing the public's sense of outrage, but these issues were beyond the subcommittee's charge and expertise.
In the remainder of this report, the subcommittee describes its attempt to determine whether diseases reported by people living in areas where ZnCdS was released are caused by ZnCdS. The subcommittee determined the biological plausibility of the diseases reported by the public to be caused by the exposures to ZnCdS and determined the extent to which the