[ Fall 2012 ]
A decades-long fight to bring clean air standards in line with environmental health science offers lessons for today.
On a raw January day in Washington, DC, Douglas Dockery climbed Capitol Hill on his way to testify to Congress about the Harvard School of Public Health study he’d been running. He would have preferred to be anywhere else. It jarred Dockery—today, chair of the Department of Environmental Health—to confront people wearing white lab coats, holding signs that read, “Harvard, release the data!” Employed by an industry-backed group called Citizens for a Sound Economy, the protesters pressed on passersby fliers claiming that Harvard was hiding “secret” data. Their message was aimed directly at Dockery.
The year was 1997, and Dockery had arrived in Washington to tell Congress that because it had promised study participants confidentiality, Harvard couldn’t share the raw data from its federally funded Six Cities study. The landmark research—one of the single most influential public health studies ever conducted—examined over 14 to 16 years the health effects of air pollution on more than 8,000 adults and 14,000 children in six U.S. cities. During that time, HSPH scientists published more than 100 peer-reviewed papers detailing their findings.
The blockbuster paper came in 1993, when Dockery’s team described what he now calls amazing results. Residents of Steubenville, Ohio—the city with the dirtiest air—were 26 percent more likely to die prematurely than were citizens of Portage, Wisconsin, the city with the cleanest air. The primary culprit: fine particulates, up to hundreds of times narrower than a human hair, which were associated with increased incidence of lung cancer and cardiopulmonary disease. “The effects of air pollution were about two years’ reduction in life expectancy,” Dockery says. “It was much, much higher than we had expected.” To Dockery and his colleagues, the results were conclusive evidence that soot produced by fossil fuel combustion kills.
That evidence was also enough for the U.S. Environmental Protection Agency (EPA), which in 1997 used the science, along with many other studies, as the foundation for the first-ever Clean Air Act regulations on particulate matter smaller than 2.5 microns in diameter. The EPA claimed the new PM2.5 rules would prevent 15,000 premature deaths annually and produce other huge benefits, among them preventing 250,000 incidences of aggravated asthma, 60,000 cases of bronchitis, and 9,000 hospital admissions every year.
But meeting the new standards would be far from simple or cheap. Manufacturing, power, steel, auto and other industries spent untold millions trying to disprove the science, discredit the EPA, and defeat the new regulations. The New York Times dubbed the clash “the environmental fight of the decade.” It embroiled the Six Cities study in a years-long controversy—one that holds lessons for public health professionals working on issues critical in this year’s election cycle, from new Clean Air Act rules and oil drilling to natural gas fracking and the ubiquitous pesticides and chemicals in our food, homes, and bodies.
A Deadly Cloud
Why Six Cities matters today
The clash between industry, politics, and science over the Six Cities study remains relevant today. Consider just a small sampling of contemporary public health controversies:
Natural Gas Fracking:
Mining and Cancer:
Ever since a toxic black cloud dubbed the “Great Smog”—made up primarily of coal-burning emissions and diesel exhaust—hovered over London in 1952 and killed more than 4,000 people within days, environmental scientists had worried about the mysterious ingredients composing industrial haze. In the U.S., that concern intensified in 1973 following the Arab oil embargo, when power plants were expected to substitute cheap, high-sulfur coal for expensive oil. What could the nasty emissions from dirtier fuel do to people?
HSPH’s Ben Ferris, a legendary public health professor who died in 1996, and Frank Speizer, professor of environmental science, proposed to find out: They would sample the air quality in six Eastern cities with varying degrees of pollution while simultaneously monitoring the health of thousands of those cities’ residents. Among their team were the wiry, intense Jack Spengler, now the Akira Yamaguchi Professor of Environmental Health and Human Habitation, who built personal air quality monitoring equipment that participants wore; and the tall, reserved Dockery, who traveled from city to city, setting up air pollution monitors in residents’ homes. Jim Ware, professor of biostatistics, joined the team in 1979. Later, Joel Schwartz, professor of environmental epidemiology, would join the team and become one of its most prolific authors.
Their goal was simple: to identify links between illness and death rates and air pollution levels. They sampled the air for toxic emissions, including sulfur dioxide and particulate matter, a brew of acids, metals, petroleum byproducts, diesel soot, and other potentially harmful substances that readily deposit deep in the lungs.
In the mid–1970s, no one had yet conducted a comprehensive study of particulates’ effects on human health. Dockery and his colleagues expected to learn that the true threat of industrial haze would stem from sulfur dioxide. But it was the fine particles that were the biggest dangers (although the study did not show how these particles created illness, a missing link critics would highlight). Another surprise: indoor air pollution was more harmful than outdoor toxins, setting the stage for years of important research.
Today, because of Six Cities, it is conventional wisdom that particulate matter contributes significantly to a wide variety of illnesses across the spectrum of life, from asthma and bronchitis to sudden infant death syndrome and lung cancer.
Public health considerations aside, the new standards forced dramatic changes on industry. The New York Times reported that old Midwestern power plants would have to install expensive pollution control equipment; states would need to invest in mass transit and other initiatives designed to reduce auto pollution; and factories that burned mountains of coal would have to switch to cleaner-burning fuels. How much those changes would cost depended upon who was doing the estimating: industry spokesmen said the bill would reach into the hundreds of billions of dollars. The EPA put the final tab at $6 to $8 billion.
As the debate grew more contentious, many experts—including Philip H. Abelson, former editor of Science magazine—pushed the EPA to delay regulations until the science was more certain. Abelson maintained that the makeup of particulate matter differed greatly from place to place. In an editorial, he queried, “How can the EPA minimize the effects of particulates if it does not know what they are or which, if any, have deleterious physiological effects?”
Others, like fellow HSPH faculty member John D. Graham, professor of policy and decision sciences at HSPH, were also critical of the EPA, arguing that the Clean Air Act’s legal framework for rule making does not allow the agency to consider costs, just health outcomes. Graham had pioneered the study of risk analysis at HSPH, having founded and, from 1990 to 2001, directed the Harvard Center for Risk Analysis. From 2001 to 2006, he led the White House’s Office of Information and Regulatory Affairs, making him what the Natural Resources Defense Council called “the second most powerful environmental official in the nation after George W. Bush.” Today, he serves as Dean of Indiana University’s School of Public and Environmental Affairs.
Over the years, Graham testified at many congressional hearings that there should be an opportunity for cost/benefit analysis during EPA rule making. “One of my key arguments is that practical people are going to do it anyway,” he says. “We shouldn’t make them do it behind closed doors. That’s not good, because their arguments are then not open to public scrutiny.”
The Battle Lines Harden
Citizens for a Sound Economy blanketed the country with ads designed to influence public opinion. The group, which the Washington Post called the “pro-industry alliance at the center of an extraordinary, multimillion-dollar campaign to turn back EPA regulations for smog and soot,” attracted grassroots supporters by contending the new rules would force bans on such American icons as backyard barbecues, farm tractors, and wood stoves.
In addition, critics from industry, members of Congress, and some governors demanded that Harvard release the raw data. “We declined,” says James H. Ware, then HSPH acting dean and now Frederick Mosteller Professor of Biostatistics. The team had promised participants that their personal data would never be released. When Harvard refused, critics accused the researchers of conspiracy and pressured Congress to hold hearings. “The issue is the quality of the science,” said National Association of Manufacturers spokesman Richard Siebert. “In order for people to ascertain the science they need to understand the background data … What are they hiding?”
“It was a painful time,” says Dockery. “You’d get up in the morning and look in the paper and there you’d be again.”
Still, the scientists held their ground. “We knew that if we released the data, it would be endless aggravation and defending against attacks,” says Ware. “To have a hostile group combing through your data looking for anything to attack you about was not something any of us relished.” Furthermore, Frank Speizer told Dockery, to release the raw data would be to allow “biased groups” to manipulate it and to set a precedent that “will undermine future research by academic institutions.”
EPA under siege
“Uncertain science” claim
When public health and industry collide, foes of regulation often claim that epidemiology is an uncertain science, says Sheila Jasanoff, Pforzheimer Professor of Science and Technology Studies at Harvard Kennedy School of Government. “The most favored method is to ‘deconstruct’ agency scientific claims, on grounds of methodological inadequacy,” she says. “The problem is that public health research often operates in zones of ignorance and uncertainty; it is relatively easy to find, or at least claim to find, ‘problems in the science.’”
The inherent uncertainty of emerging science leads to fiery rhetoric on both sides—which is unfortunate, Jasanoff adds. “The constant debates about ‘good science’ and repeated charges of overregulation undermine trust in government and hinder a mature understanding of how to live prudently in complex industrial societies that will never be risk-free and where full scientific certainty on many issues will likely take very long to achieve.”
Even today, the Six Cities debates linger. John Graham applauded HSPH’s decision to give its data to the nonpartisan organization Health Effects Institute for analysis. But 15 years later, he remains frustrated that Harvard didn’t share the original data earlier. “These findings are still utilized around the world,” Graham says. “They sit as a foundation for multibillion-dollar decisions in China, Brazil, and elsewhere. I would still like to see the data be made publicly available. It’s the basic principle of transparency in science.”
But the EPA, too, was under siege—from lobbyists and from Congress, which demanded the agency produce so-called “secret data” on which the new rules rested. In February 1997, EPA bowed to the pressure and urged Harvard to do so. As a compromise, the team came up with the idea of asking an independent scientific panel to audit the researchers’ findings. They gave a warehouse full of data to the Cambridge, Massachusetts–based Health Effects Institute (HEI), which was funded by both the automotive industry and the EPA.
It took HEI three years to reanalyze the data—an agonizing period of limbo for the scientists. But it was worth the wait. In 2000, HEI scientists confirmed the original Six Cities findings. It was a huge win for the School.
In 1997, while HEI was auditing the data, President Bill Clinton approved the new Clean Air Act’s PM2.5 regulations and tightened ozone standards. In 1999, Alabama Republican Senator Richard Shelby, still simmering about Harvard’s “hidden” data, inserted a single sentence into a 4,000-page budget bill that would change everything for future researchers. The still-controversial Shelby Amendment calls for those university scientists working on federally funded projects to share their data with anyone who requests it via the Freedom of Information Act.
When the issue of sharing primary data first arose, critics like HSPH’s Frank Speizer feared such a rule would dampen future research by dissuading potential participants whose confidentiality could no longer be protected. Today, the issue is so fraught that, even within HSPH, scientists find themselves on opposing sides. Doug Dockery calls the Shelby Amendment “a direct assault on research conducted by universities,” because privately funded studies aren’t subject to the same rules. In contrast, Jim Ware says, “As a matter of principle, the Shelby Amendment is right: When the federal government pays for research … that research ought to be made available for scrutiny by others and for debate and examination.”
The Long View
Today, Dockery looks out his 13th-floor window across the Charles River at the Cambridge skyline, a view that, decades earlier, had often been obscured by urban haze. “I can see a long way,” he says. “That’s gratifying.”
Over the last 30 years, air quality nationwide has improved dramatically, due to Clean Air Act rules based in part on Six Cities research. In 2009, Dockery and colleagues Arden Pope (now at Brigham Young University) and Majid Ezzati (now at Imperial College London) demonstrated that from 1980 to 2000, reductions in exposure to fine particulate matter had increased average American life spans by 1.6 years. “That’s huge,” Dockery says. “If you got rid of all cancers, the net effect on average life expectancy would be two years.”
The Clean Air Act and the policies triggered by HSPH’s Six Cities study are classic examples of how public health should work: good science shapes public policy, and policy, in turn, saves people’s lives.
A Steel Backbone
On a crowded shelf in his office, Dockery keeps two six-inch-thick binders of correspondence and media clippings from the Six Cities fight. Buried in them are memories—many painful—but also lessons for today’s public health professionals.
For Dockery, two stand out. First, “Solid, quality science does stand up over time.” Second: “How you present the information—how you translate the data—is extremely important.”
He believes the PM2.5 standards survived because, for the first time, the science made it possible to calculate the costs and finger the sources of air-pollution-related disease.
“We provided the basis for quantifying how many hospital visits, how many asthma attacks, how many COPD [chronic obstructive pulmonary disease] cases, how many heart attacks, and how many deaths were associated with these air pollutants,” he says. “It completely changed the discussion. When you actually used those numbers, suddenly the cost/benefit analysis became very clear—and suddenly, the benefits were found to far outweigh the cost of controls.”
Years later, Office of Management and Budget (OMB) analysis confirmed Dockery’s claims: in a 2011 report, the OMB stated, “Of [EPA’s] 20 air rules, the rule with the highest estimated benefits is the Clean Air Fine Particle Implementation Rule, with benefits estimated at a minimum of $19 billion per year. While the benefits of this rule far exceed the costs, the cost estimate for the Clean Air Fine Particle Implementation Rule is also the highest at $7.3 billion per year.”
Although not everyone agrees with OMB’s assessment or even with the legitimacy of assigning a price tag to health outcomes (what is the monetary value of a human life saved?), many believe such data are more important than ever. The industry lobby has gained strength in the 15 years since the Six Cities brouhaha. In 2011, a hearing before the Republican-led House of Representatives subcommittee on new Clean Air Act rules was entitled, “Lights Out: How EPA Regulations Threaten Affordable Power and Job Creation.”
Challenges in Today’s Politics
The debate goes on
The controversy over standards for fine particulate matter air pollution continues today. In June 2012, a federal court order forced the EPA to propose new, tighter standards; the agency settled on reducing the allowed annual level from 15 micrograms per cubic meter to a range between 13 and 12.
But a 2011 report by the American Lung Association, Clean Air Task Force, and Earthjustice claims that this reduction doesn’t go far enough. Their analysis, which cites Six Cities findings, argues that at those levels, a maximum of 15,000 premature deaths would be averted annually. The coalition argues that the EPA should adopt a more stringent annual limit of 11 micrograms per cubic meter, which its analysis shows would prevent nearly 36,000 premature deaths yearly.
The EPA is expected to issue final standards in December 2012.
Seen through a 2012 lens, it may be surprising that the Six Cities imbroglio wasn’t a strictly partisan fight. Unlike today, earlier environmental battles didn’t erupt along party lines. It was President Richard Nixon who established the EPA in 1970, setting the stage for a string of Republican environmental accomplishments, including the first major reauthorization of the Clean Air Act in 1990 under George H. W. Bush. “When you look at the record,” says Dockery, “the Republican administrations have been better for environmental controls than the Democratic administrations.”
Dockery believes today’s political environment is actually far more difficult for science than it was in 1997. “Before, there was the cry that we wanted the best science for defining the regulation,” he says. Now, he adds, referring to debates like those over global warming and certain childhood vaccinations, “What we’re seeing is a total rejection of science as the basis for making regulatory decisions.”
HSPH’s John Spengler has become convinced that scientists studying today’s environmental problems need both new communication skills and a steel backbone. “You really have to know you’ve got the personality to do this,” he says. “If you choose a public health career and you believe in it, and if you have an urgent public health message that needs to be delivered, this is part of the territory.”
To Spengler, that means public health educators have a new job to do: teaching scientists how to lead and how to deliver their messages to policymakers. “We teach people to be statisticians, epidemiologists, lab analysts, exposure scientists,” he says. “But we must also equip them for the big fights.”
Elaine Appleton Grant is the former assistant director of development communications and marketing at HSPH and a public radio reporter.
HSPH researchers study environmental threats to health, such as hazardous substances found in the air, water, and wherever people live and work. The interplay of genes and environment on health and the importance of occupational safety are also key.