Preventing Harm – Protecting Health: Reforming CDC’s Environmental Public Health Practices
Opening Statement By Chairman Brad Miller
Good morning. Welcome to the hearing: Preventing Harm, Protecting Health: Reforming CDC’s Environmental Public Health Practices.
This is the third Subcommittee hearing to examine the performance of the Agency for Toxic Substances and Disease Registry (A-T-S-D-R). Today, we also examine the work of its sister agency, the National Center for Environmental Health (N-C-E-H). Together, these offices are the Centers for Disease Control’s (CDC) experts in performing environmental health evaluations.
In prior hearings we documented problems with ATSDR’s work on formaldehyde and the safety of trailers provided to families that survived Hurricane Katrina. We also documented problems with ATSDR environmental assessments at Camp LeJeune, Vieques, Puerto Rico and Midlothian, Texas. Three of the four cases mentioned have seen the health evaluations withdrawn by ATSDR, and the fourth case is under review. They are to be commended for being willing to admit to mistakes—but today we will hear reasons to worry about what they are doing to set the record right. We will examine one of these past examples, looking into current actions by the CDC to launch a new public health evaluation in Vieques Puerto Rico.
Additionally, we are releasing a staff report that documents serious flaws in an article written by CDC staff in 2004 to respond to the District’s lead-in-water crisis. That article was built on significantly incomplete data for one of the two studies and unreliable data in the other study. But the message to District residents in the article was very clear: no serious harm resulted from the elevated lead in water situation. After that article was published in the Morbidity and Mortality Weekly Report-the MMWR- in March 2004, the public clamor went away, press coverage died down, and most of the Federal staff dispatched to assist the City validated the message that there was no crisis by quietly returning to their home agencies. The authors knew there were problems with their studies, but in their disclosure on the limits of their data, they said not one word about missing data or confounding variables.
This Subcommittee cannot possibly identify every mistaken evaluation, assessment, report or article done by ATSDR or NCEH staff,and that is not the role of Congressional oversight. The CDC must take all necessary steps to set these offices on the right path. Sometimes to get on the right path, we must understand what constitutes the wrong path. Between our previous hearings, and today’s testimony from the Government Accountability Office (GAO) it is clear that the wrong path includes:
- Conducting studies designed to make it impossible to find a health problem.
- Analyzing data that is incomplete, inaccurate, or irrelevant to the underlying question without disclosing the known limits of the data.
- Responding to critics by attacking their knowledge or their motives.
- Failing to have rigorous and consistent reviews of study designs, data collection and quality, analytical methods and conclusions.
- Failing to have consistent policies and procedures for conducting public health research and interventions and for publications.
All of this needs to change if ATSR and NCEH are to succeed.
We need more honesty and transparency and less attitude from these offices. When you work at a public health science agency and the words more frequently used to are “haphazard,” “hit-or-miss” and “ad hoc”, maybe you should pause and reflect.
This morning we have a new analysis that reworks part of the MMWR article on lead in DC’s drinking water, with more complete data on blood lead tests for District residents. The NCEH staff had more complete data, but they scrubbed it in a way that can’t be evaluated by experts or by the public. They provide no real numbers of children with elevated blood lead levels—something that residents would understand—and make it impossible to compare their raw numbers to numbers reported by the District or this Subcommittee. Most important, the other years in this longitudinal study were not “scrubbed” in the same way the newly complete 2003 report was, making the validity of the entire exercise questionable.
Undoubtedly much of ATSDR’s and NECH’s problem is a failure to communicate in the words of Cool Hand Luke. But we have heard a great deal of evidence that the quality of the science is simply not consistently what it should be.
I congratulate Dr. Frieden for initiating a search for a new leader of ATSDR-NCEH. We need a new team there that can restore staff confidence, provide guidance about quality and processes, and give to this country a function we so desperately need: reliable, expert evaluation of environmental health dangers. There are many talented committed professionals at ATSDR and NCEH. The public and those professionals deserve that leadership.
Witnesses
Panel I
1 - Mr. Cynthia A. Bascetta
Director Public Health and Medical Services, Government Accountability Office (GAO) Public Health and Medical Services, Government Accountability Office (GAO)
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2 - Mr. Stephen Lester
Science Director Center for Health, Environment & Justice (CHEJ) Center for Health, Environment & Justice (CHEJ)
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3 - Dr. John P. Wargo
Professor of Environmental Risk Analysis and Policy Yale University Yale University
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4 - Dr. Marc Edwards
Charles P. Lunsford Professor Department of Civil and Environmental Engineering, Virginia Polytechnic Institute and State University Department of Civil and Env
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Panel II
1 - Dr. Robin M. Ikeda, MD MPH
Deputy Director Office of Noncommunicable Diseases, Injury and Environmental Health Office of Noncommunicable Diseases, Injury and Environmental Health
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