just stimulating conversation
Andrew Maynard: Okay, sounds like we're live. Welcome to Gulf Oil Unplugged or rather Risk Science Presents Unplugged, Gulf Oil. Before we start there I just wanted two formalities I need to go through, especially because we're live webcasting this, so I should also say welcome to the people watching this by the webcast. If you are watching the webcast of--because you're not here, we've got a couple ways in which you can join the conversation and add in your comments or questions. The first is if you go to the Unplugged website, you can add a comment there and if we're really lucky that will trickle through to me here, so I'll be able to pick that up. By far the easiest way of doing this is via Twitter. So, if you're young and into the 21st century groove and using Twitter, you can post something on Twitter with a hashtag. I've lost my hashtag. Now, where is my hashtag, UMRCUP. So, hashtag UMRCUP and that will miraculously appear on the screen in front of me. So if you have a question, and again if we're lucky, I should be able to pass that on to the panel here.
The audience that we have here, just one other point of order, you'll see we have a standing mic here. So, if at any point you have questions or comments for the panel, please just come up to the mic and I'll bring you into the conversation. Don't wait to the end because you won't have a chance to ask questions then. As soon as you feel the urge to join the conversation, please do come in and join because this is going to be a lively conversation. I should also add that, as well as the live event here, there are web resources associated with this. You can go to the website www.umriskcenter.org/unplugged and you can have a look at a number of things including background documents, including the archive footage of this particular event on video and one or two other pieces of information. So, I do encourage you to check that out as well. You can also add additional comments or questions and direct them to the panel for approximately a week after this event as well.
So, without further ado, let's begin to get into things here. The subject to today's discussion is obviously the health impacts of the Gulf Oil disaster. What we know, what we don't know, where we go next. And of course we're almost at the twelfth month anniversary of what happened with Deepwater Horizon last year. To discuss this, I'm very pleased to have a very distinguished panel. So really quickly going down the line, on my right we have Margaret Kitt who is the Deputy Director for Program of the National Institute for Occupational Safety and Health, NIOSH, and over the last 12 months you've been intimately involved with both NIOSH response to the disasters as well as the federal response. Next to Margaret, we have Richard Kwok. Richard is a Lead Associate Investigator for the National Institute of Environmental Health Sciences, NIEHS, Gulf Long-term Follow-up Study. Very clever title. You probably can't hear just with me saying it, but the acronym of that is, the GuLF Study. So, it's an acronym to that actually uses one of the words. I don't know how long it took them to work that out, so maybe you'll tell us.
Richard Kwok: Dale actually thought that up. She's the P.I, Dale Sandler.
Andrew Maynard: Right. Right. Okay, so that the credit goes to her. We're going to hear a little bit more about the study. It's a 10-year study looking at 55,000 workers associated with the cleanup. Next along the line we have David Uhlmann. David is Director of the Environmental Law and Policy Program at the University of Michigan. And before coming to the University here, he spent 17 years with the Department of Justice, the last seven of which he was chief of the Environmental Crimes Section. He has a keen interest in the criminal charges that may result from the Gulf oil spill and we'll talk a little bit about that in a broader sense a little bit later on. And then finishing the line up, we have Al Franzblau. So, Al is an MD. He's also Associate Dean for Research here at the University of Michigan School of Public Health, has a deep interest and deep expertise in occupational health. And he also has, over these last 12th months, had an interest in the health impacts of the Gulf oil spill, and particularly the impacts on workers and people in the local community.
So, just to kick off the conversation here, a few words of introduction although I think most people in the audience and watching these will have a pretty good idea of what happened 12 months ago. So, as we know, on April the 20th last year, there was an explosion on the Deepwater Horizon oil rig in the Gulf of Mexico and this led to a catastrophic failure. Eleven workers died in the explosion and pretty much the world watched as events unfolded, as the rig collapsed, as we failed to cap the well, and as oil began to gush into the Gulf of Mexico from the seabed floor at 5,000 feet below the surface. And we began to realize that this was an event that we really had very few ways of addressing. And this has happened--obviously there was a scramble trying to do something about it, to try and cap the well, but also to try and clean up the oil that was spewing out, an incredible amount of oil. I'm looking through my figures. I actually have the figures here for how much oil. It was in the millions of gallons. I don't know whether any of you remember. It was 200 million gallons of oil, an incredible amount of oil. It was one of the largest, in fact, I think the largest maritime disaster associated with the petroleum industry to date. But as we try to deal with this, as organizations, workers scramble to try and clean up the mess, we had a tremendous number of workers going down there. And at the same there were questions about how this was going to affect their health, and how it was going to affect the health of other people involved in both the cleanup, and being exposed to this oil. And that raised a lot of questions, questions that have been going on for the last 12 months, and questions that are still being raised.
So to start exploring that, I thought I would start with you, Margaret. First question, is what was it like from the government's perspective as this began to unfold. So you were sitting there with NIOSH, the lead agency in terms of understanding how to respond to certainly novel occupational health risks. What was it like being in the agency and what was the response first from the agency's perspective and the government's perspective.
Margaret Kitt: Well, as soon as the event occurred obviously, we start putting together our plans, our educational materials, try to assess the situation as to what we think the response may entail. Soon after the response, the National Response Team started having phone calls, of which NIOSH is one of the agencies that participates in those phone calls, to try and see what the circumstances were at the given time. On May 2nd, Dr. David Michaels, from OSHA, called Dr. John Howard from NIOSH and asked if we would participate, along with NIEHS, down at the federal meeting in the Gulf. And so on May 3rd, we held that meeting, meeting with PPE officials, as well as officials from Unified Area Command, and started to walk through the process of what they were planning for, what some of the PPE matrices that they were putting together for work-hazard analysis were going to be.
Andrew Maynard: Sorry, PPE is personal protective equipment.
Margaret Kitt: Yes. So, I think we were just initially trying to get a glimpse and gather information of what was going on, and what we thought could be the worst case scenarios that we might have to prepare for, and how we would take the information as we moved along and developed our procedures to help work through the process.
Andrew Maynard: And in terms of the sorts of things that the community were worried about, I was going to come to you, Al, because here we had a situation where people were being exposed to crude oil and everything that is part of crude oil. What were the sorts of acute and possibly chronic health effects that the people were interested in and concerned about?
Al Franzblau: Well, there are a variety of things. A very complicated mixture of hydrocarbons that are coming out of the ground; crude oil. Crude oil varies around the world, so this is light crude from the Gulf, whatever that is. And obviously there is also in the mix the dispersant. Many, many gallons of dispersant were spread around. And there acute things, irritation to skin and mucous membranes, possible respiratory effects from that irritation. There are possible nervous system effects from acute and/or chronic exposure to usually the lighter, more volatile organics that are inhalable. And then there are the concerns about long-term effects, cancer and non-cancer effects. Crude oil contains benzene, a known human carcinogen. It has poly-aromatic hydrocarbons, which are known human carcinogens. And obviously the issue is do we have a completed pathway of exposure. And if so, to what extent? So, those are I think among the major concerns there.
Andrew Maynard: And we'll certainly pick up that a little bit later in terms of what's actually known about the health impacts. But I want to come back to Margaret and ask. So, we have the situation where a lot of people going down there responding very rapidly to this oil spill. We know that there are certainly potential health impacts associated with working with crude oil and its components. What sort of health impacts were seen amongst these workers in those early days?
Margaret Kitt: Well, in those early days, we are just trying to start to put together some of the injury and illness information that was being collected by BP. And most of that information was being collected at different staging areas that were set up. By far, overall, both during the initial stages as well as later, we saw minor injuries, things that you would expect from having that many workers in any given location for an extended period of time. Certainly, things like bites and animal stings, you know, bee stings, et cetera, mild things to that effect, some motor vehicle accidents, water vehicle accidents. So it's mostly injuries, but we did also see some people coming in for respiratory complaints— headaches, dizziness, and heat stress was a big issue obviously.
Andrew Maynard: Right, right. But actually that's interesting. I think this is something we'll come back to. That heat stress seemed to be one of the most significant things that we saw coming up rather than some of the things you might associate with getting oil on your skin or breathing in the fumes. Did that change over time, that pattern of impact?
Margaret Kitt: Well, certainly, the heat stress paralleled the heat indexes as they would go throughout the months. So obviously, as you would expect, we would have more cases. However, that was also the time when the heat management plans were stronger and put in to place and so I think that kind of ameliorated some of the heat stress issues that came out. The other thing, I guess, I could mention also was, you know, with this population, I'm sure we'll talk about it more, there was a lot of preexisting disease and that played a significant impact as well as to what we saw.
Andrew Maynard: And I certainly do want to come back to that and I want to move to David in a second to talk about some of the legal issues associated with this. Before I do that--so we talked a little bit about what it was like in NIOSH. Can you talk a little bit more about the coordinated federal response because that's something that particularly interested me. Did the agencies play together well or was it chaos as usual?
[ Laughter ]
Andrew Maynard: So I shouldn't say chaos as usual.
Al Franzblau: That's not fair.
Andrew Maynard: I used to work in the federal government. I can say that.
[ Laughter ]
Margaret Kitt: Well, certainly when we arrived, one of our highest priorities was to make sure that we knew who was there working. To develop a roster system to be able to account for the workers, because we learned from the World Trade Center event that creating these lists retrospectively is not, certainly not, the optimal way to go. So we wanted to create a perspective listing. We put together some technical consultation to BP and unified area command as to how they might be able to go about doing that.
Andrew Maynard: And when we talk about we here, is this just NIOSH?
Margaret Kitt: NIOSH. We were working, obviously, in conjunction with OSHA.
Al Franzblau: And who was the Unified Command?
Margaret Kitt: Unified Area Command actually was a combination of the Coast Guard. They had a Federal On Scene commander, working hand-in-hand with BP, and so that would be the Unified Area Command.
Andrew Maynard: Right, right. So I know you've been around awhile in NIOSH. You've seen how--
Margaret Kitt: A few things.
[ Laughter ]
Andrew Maynard: Well, no, I was thinking actually you probably started after high school and you'd be there at least 10 years or so.
[ Laughter ]
Al Franzblau: Nice Save.
Andrew Maynard: Yeah, backing out of that fast. But--and you've seen how the federal agency tends to respond to these big national disasters. Is your sense that, that in this particular case, the federal government had learnt from past episodes?
Margaret Kitt: Yeah, absolutely. Certainly there are always challenges and being so geographically spread was challenging in and of itself. But this was probably the best coordinated effort I had been a part of, and challenging because it had so many agencies involved. But, I think we had developed over the years, through working together and working on some projects, we developed a lot of relationships between the Coast Guard certainly, OSHA, and NIEHS, NIOSH, and state and local health departments as well. Now, obviously we didn't have a lot of experience working with companies like BP, but I think the logistical support that merged between BP and the Coast Guard was very supportive and, you know, there were always challenges and things would come up everyday, but overall I think it was a pretty well coordinated response to protect the workers.
Andrew Maynard: Now, at this point I do want to bring you in, David, on the legal side. Because here very clearly we have one of these situations where something was happening in the environment we had to respond fast, which meant that people were going out into the field being exposed. So there was this possibility of corners being cut, raising the issue not only of potential impacts, but also raising questions of what was legal here, what was appropriate, what would be the long-term ramifications of what went on. So, if you just put this in a legal context for us if that's possible.
David Uhlmann: Okay the--
Andrew Maynard: Within 2 minutes.
[ Laughter ]
David Uhlmann: Within 2-minutes. Oh yeah, a 2-minute version of the legal perspective. So, the President has called the Gulf oil spill the worst environmental disaster in US history, and as Andrew pointed out is the largest accidental oil spill in world history. So, the environmental impacts are tremendous and like the public health impacts, still largely unknown. We've never had 200 million gallons of oil discharged into any ecosystem, and certainly not one as fragile and already damaged as the Gulf of Mexico. So, we don't know the long-term environmental impacts. But it's very important to also be talking about, as we are today, the public health impacts because first of all this tragedy, as significant as it was from an environmental standpoint, this is a tragedy that began with 11 people losing their lives, which never should have happened. It's a tragedy that's continued with at least the potential, as we've been talking about, of workers being exposed to the harmful health effects. And there is a third dimension that we might talk about as well, although it's an even greater unknown which is, you know, what is the effect on the food chain on the Gulf. I mean the Gulf is the nation's leading source of seafood and we don't know what the effect was on seafood and what the potential public health effects are. We've been assured by the government that the seafood from the Gulf is safe. Although I was in New Orleans a few months after the spill ended and had Gulf shrimp and came home and told my wife how good it was and she wanted to know what I was thinking [ Laughter ] eating Gulf shrimps soon after the Gulf oil spill. So, I mean there's a lot of different ways that we need to look at public health impacts and from a legal standpoint that means first of all making sure that BP and the other companies involved are held responsible not only for the environmental damage they've caused, but also for any public health effects they've caused. Both are tricky because we don't know exactly what they are. So, you know, what we want to do in the legal system, at least looking backwards, is put a price tag on the harm that companies have caused both ecologically and from a public health standpoint. And that will be challenging because we don't know the full extent and we won't know for many years. And then the other thing we want to do from a legal standpoint is try and respond to the situation and perhaps even make changes to the law in ways that helps us prevent this type of tragedy in the future. And I worry that there we may have even greater challenges because we don't seem to be all that interested in altering any of our behaviors. That's something we might talk about too because if we don't want something like this to happen in the future, there needs to be change and change not only within the companies involved.
Andrew Maynard: That's actually a great segue for beginning to bring Richard into the conversation. But before I bring you in, Richard, something does intrigue me. So, you brought up this issue of having to work out what the cost of the impact is so you can begin to enable associated parties such as BP to pay that cost. At the same time, you've got this strange mix where everybody involved is trying to do something about making the situation better. So, you take BP for instance, clearly they've been actively involved in both working with the federal government and working with local communities to try and resolve the problems created by the mess. At the same time they're being held very strongly accountable for it and there's that threat over them of legal action. In fact it isn't really a threat, there will be legal action. So, how do you work with this strange dynamic where a company is obviously trying to do good, and yet maybe not trying to do enough, and at the same time they've caused an awful problem which they've got to be held accountable for?
David Uhlmann: You know, well this is a challenge that actually began with the response as Margaret was talking about in BP, and this troubled a lot of people in the United States. BP was in a very central role in the response effort. They were part of the Unified Command that Margaret described. They were legally required to take care of the response, to clean up the oil, to make sure that the damage to the communities along the Gulf and to the ecosystem on the Gulf was as limited as possible. So, we had this strange dynamic from the get-go, where the responsible party is also responsible for the cleanup. And going forward, you are right that, you know, BP on the one hand is--I mean we--I think we give credit where credit is due. BP has been vilified and perhaps rightly so for causing the spill and for the negligence that led to the spill. But BP has done a lot right in responding to it. And I think, although it seems like that would be intentional with the fact that they're also being sued by everybody, the reality is at least in their dealings with the government they will get credit when they're negotiating resolutions which they no doubt will do of the various government actions brought against them. They will get credit for the fact that they have done right by the Gulf in the weeks and months and soon to be years since the spill occurred. So, yes, there's a bit of attention there but I think it's in BP's interest short-term and long-term to do everything it can to be responsible and maybe to do a better job in spill response than they did in spill prevention.
Andrew Maynard: Right. Al.
Al Franzblau: Well you raised a curious question about--and it is an interesting thing that BP has had a central role in the cleanup effort as part of the joint command. I wasn't aware of that technical detail. But what's the alternative, and I mean there are alternatives. You know, they can be uninvolved and the government could be picking up the tab and maybe they try to get the money back afterwards or something and--but you know, this is the situation we have and I'm curious what are the potential alternatives?
David Uhlmann: No, I think it's a fair point. I mean this was a source of a lot of criticism. At the time of the spill, everybody was--you know, I think people thought you had the fox guarding the chicken coop. The flip side of that is we have this sort of basic fundamental concept in life that you make a mess, you clean it up. They made a really big mess and they needed to clean it up and they need to be responsible for cleaning it up and the reality is although people think the federal government should have been able to do everything here-- stop the spill, clean it up, protect the environment, protect public health. But the reality is, you know, the federal government is not in the drilling business. BP is in the drilling business. They're the world leader in the drilling business. They are the ones with the expertise to figure out how to stop a spill like this and how to prevent further damage. Although I would say that one of the lessons, there are many lessons from the spill, but one of the lessons from the spill is that a whole lot more attention needs to be paid to spill prevention and spill cleanup and mitigating the harmful effects of spills.
Andrew Maynard: So before we get to Richard, we are going to get to you in a second, let's take a question. If you can say who you are as well.
[Audience- Levitz:] Of course. My name is Rachel Levitz, and I have just 2 questions. One has to do with the government saying that the seafood was safe. I was just wondering if they actually measured levels of toxins in the seafood before they actually just told people that they were safe, especially since we know crude oil is so toxic and a lot of these, like fish and things are bottom feeders and if they're eating sediments that has bits of crude oil on them, how safe is that really? And also two, did BP educate--and a completely different offset of questions. Did BP actually educate its workers to the toxic effects of crude oil to ensure that they actually would wear the personal protective equipment? And was that personal protective equipment that they were using, different respirators or things, was it fit tested? And being in such a hot environment, did the workers actually use it properly even though it would be potentially uncomfortable?
Andrew Maynard: Great, thanks. So, let's hold on to the second question and come back to that. The first question, Richard, did you want to start with that and then we can sort of move in to talking about the health impacts and the implications of the GuLF Study more generally?
Richard Kwok: I can't speak specifically because NIEHS wasn't involved in terms of the seafood testing but--
Andrew Maynard: But I would ask the whole panel that, does anybody have anything to say about the safe testing on--so you ate gulf shrimp, so [ Laughter ] that makes you the expert.
[ David Uhlmann:] You know, I knew the government did do test and I think FDA--
Margaret Kitt: Right, I was on a number of phone calls with the Department of Health and Human Services where FDA would report if not daily, certainly every other day, the testing that was ongoing. I'm no food safety expert but I know that there was plenty. There was quite a bit of food testing going on.
Richard Kwok: And I think it's systematic too. I think a lot of samples were collected in different areas around the gulf and then all was tested.
Andrew Maynard: And I certainly remembered at the time there was a lot of press over this because the standard tests, if you remember, were the sniff test. I mean just does the stuff smell contaminated and that seemed to be the public relation disaster at the time and the federal government went incredibly fast from that point to introducing far more quantitative tests.
David Uhlmann: Well, they, you know--they closed fisheries all across the Gulf for many months over the summer and they only reopened them once they felt they had done adequate testing and I don't question that nor I want to be an alarmist. I mean it may well be, and I hope it's true, that seafood from the Gulf is perfectly safe. My point in raising this as sort of a third area of public health and potential public health impacts is simply that I don't think we know. I mean I know from an environmental standpoint, we don't know what the long-term effects of putting this much oil into the ecosystem are. And my fear is we also may not know therefore what the long-term effects are on the entire food chain. I mean there's a lot of microbes in the Gulf that did a lot of work apparently eating up a lot of this oil which is a remarkable, you know, resilient response by nature to this type of tragedy. But now we've got all that decomposing on the ocean floor and being eaten by aquatic life that's part of the food chain and so how does that--what happens with that? I just don't know that we know the answer.
Andrew Maynard: Right, right. So then, let's come to you, Rich, and I want to sort of get into talking about the health impacts just by reading this out from a recent paper. So, that the panelists are all aware of this paper, it was published in the New England Journal of Medicine just a week or so ago by Bernard Goldstein and colleagues. But what particularly strikes me about the paper is just the first few sentences which really sum up everything we know about the potential health impacts of oil spills at the moment. So, reading from this paper, [QUOTING] "One year after the Gulf oil spill, the full magnitude of the environmental, economic, and human health effects of this major disaster remain unknown. Despite a growing literature describing the impacts of oil on health, it is difficult to respond to the many questions asked by clinicians and the public about the spill or the risks of future spills." In other words, despite everything that's happened in the past, we pretty much know nothing at the moment. Is that a fair summary?
[ Laughter ]
Richard Kwok: I think--I mean we know some things from past spills like the Prestige spill in Spain and others, but of all the recorded spills in modern history, only 8 have been studied extensively for long-term health effects. And so as part of the GuLF Study research and doing background, we have investigated extensively those health outcomes and what has been reported and then built that into our study to look for further studies.
Andrew Maynard: Right. So, tell us a little bit about the GuLF Study. What are you hoping to achieve and what you're actually going to be doing with it?
Richard Kwok: So, the GuLF Study is a prospective cohort study that looks at all the work, cleanup workers, who were involved in the response. And through a telephone based questionnaire, we will call 55,000 individuals and enroll them into a long-term follow-up study and ask them a series of questions about their background, their family history, what they did during the cleanup response and then follow them up for any, you know, long-term health effects that then may come up through either cancer registries or the death index.
Andrew Maynard: Right.
Richard Kwok: And then a subset of those individuals will have more intensive follow up through a home visit where we'll collect environmental samples around their house. We'll collect some bio-specimens and then ask them some additional questions.
Andrew Maynard: So in terms of the sampling and the bio-specimens, what are you looking for to see whether those evidence of exposure, and presumably you're trying to quantify that exposure prospectively as well?
Richard Kwok: We're looking at biomarkers of effect. And we're not specifically looking at biomarkers of exposure because--I mean that's an important distinction-- because the body metabolizes many of the hydrocarbons out in a matter of hours or days. And so especially with benzene, if you find a measured level of benzene in the blood now, there's almost no way that it would be associated--
Andrew Maynard: It would have been in a recent exposure.
Richard Kwok: Exactly, it would be a more recent exposure, and so we're really looking more at biomarkers of effect.
Andrew Maynard: And is there an issue of confounding factors here? So, you look at effect, how do you tease out what was directly associated with the cleanup operation and what might have come from other sources?
Richard Kwok: That also is a very complicated question that--
Andrew Maynard: I didn't say you're going to have an easy time here.
[ Laughter ]
Richard Kwok: I thought I was going to get out without having to say anything. No. But, you know, obviously we're very interested in occupational exposures, residential exposures that they may have where they live, if they live next to an oil refinery, or they have jobs that put them in contact with other petroleum products. If they pump gas before they got their blood sample, I mean that those are all other sources of exposures potentially.
Andrew Maynard: Yeah.
Al Franzblau: I'm very curious about this because I'm not involved and I'm aware that the study was going on but when you talk about these 55,000 workers, cleanup workers, but to what extent are these regular employees of BP or other entities who, you know, might work at a refinery or work on a barge, or, in other words, have what I'll call the more routine occupational opportunities for exposure to these materials, or derivatives of these materials, as opposed to the people who might have had a one time opportunity for a couple of weeks when they're doing some cleanup? As you're intermediating, there really is no objective exposure assessment of what happened to them when they were doing the cleanup. It's exceedingly difficult to do that prospectively. I am not criticizing because I don't know how you do it anyway, but it makes it really hard. And so I was wondering a number of things. There have been a lot of exposure measurements down in the Gulf and I don't know how many but I know that BP has done a lot and the government is doing a lot and to what extent those objective exposure assessments may somehow be incorporated into what you're collecting in terms of outcome data?
Richard Kwok: Well, we have a team led by Trish Stewart and Mark Stenzel who are helping us with the exposure assessment and this is a— a retrospective exposure assessment is very, very complicated. We are leaning heavily on the HHEs that NIOSH had done, environmental samples that EPA has taken and then also some of the industrial hygiene measures that a contractor for BP had collected. And incorporating all that information into what's known as a "job exposure matrix" and then based on how the individuals report what they did. You know, the complicated thing is that we can then see where the individual worked, when they worked, and then who they work for but we don't know what exactly they did and when--
Al Franzblau: Unless they tell you.
Richard Kwok: Unless they tell us, yeah.
Al Franzblau: Obviously that's fraught with issues.
Richard Kwok: That's fraught with issues in terms of recall bias that--and also add another wrinkle is that the exposure to the crude oil varied not only spatially but temporally as well.
Al Franzblau: Right.
Richard Kwok: So, it varied depending on where you did it, when you did it, and what you did, will have an impact. So even if you have the exact same job and you performed it in Mississippi versus in Alabama, in June versus in August, it would be a very different exposure even though you did exactly the same thing.
Al Franzblau: You know, there is the exposure to the crude and the potential physical outcomes that I think we even focused on, but the limited literature that we were referring to before that actually is limited.
Richard Kwok: Right.
Al Franzblau: Probably, in my opinion, there aren't that many studies but some of the best studies are actually the studies that looked at the psychosocial outcomes and those in fact have most longitudinal studies especially up in Alaska. I'm curious what may be done here for communities along the Gulf in terms of, you know, if nobody can fish, then that's a huge impact on a fishing community. And I don't know what's being done.
Richard Kwok: We have sections in our questionnaire to look at some of the psychosocial impacts. I mean obviously this is a very traumatized region especially after hurricanes Katrina and Rita. And so, we are interested in that but--you know, this is not a traditional occupational cohort per se in that these aren't all professional oil rig workers that have a long occupational history of working on the rigs. And we have some of those individuals and we hope to incorporate some of them into our study. But most of these are just general members of the community or unemployed fishermen that, you know, wanted to help out or, you know, that had no other alternative but to help out. And so, I mean it's a very eclectic group and a heterogeneous group of individuals.
Andrew Maynard: That raises a number of questions. It gets back to the earlier question of training and what training they received. It also brings out the question of what their baseline health was before they went in and it also raises questions of, well, who is responsible for their health and well-being if you're just having these people, and not quite literally plucked off the street, but you're drawing pretty rapidly from a population which is going to be different from your usual workplace cohort. Margaret, I know that you wanted to--
Margaret Kitt: I just wanted to ask Richard a quick question. The Coast Guard, are some of their folks being incorporated into the GuLF Study or are they sort of looking at their population separately because obviously that is a subgroup that, you know, has quite a bit of baseline information on their folks that might have been participating in the response and would have some comparison data for you. I wasn't sure if they were doing a separate study or if it was part of?
Richard Kwok: We're partnering with the Coast Guard and we plan to incorporate some of the Coast Guard members into our study, and the Coast Guard was distributed nationwide. I think that they pulled a lot of active units from all over the country to participate in the response. So we are partnering with them and so, there will be some Coast Guard members within the 55,000.
Al Franzblau: I have a question that harks back to a comment that we talked about before about who's paying. This is an enormous study, 55,000 people followed for 10 years. I mean I could do some back-of-the-envelope calculations and you're into the hundreds and millions of dollars basically over the long term. And I'm just curious, who's actually paying for this?
Richard Kwok: The NIH Director Francis Collins had committed 10 million dollars to get the study off the ground and we've been using that. BP has provided a gift to the NIH of 10 million dollars of which 6 million of it has gone directly to the GuLF Study.
Al Franzblau: People may not be aware that the NIH has an independent foundation that accepts gifts that are unrestricted and can be used as the director chooses.
Andrew Maynard: So presumably BP has no say over how this money is spent?
Richard Kwok: Not presumably, definitely.
Andrew Maynard: Definitely, right.
Richard Kwok: So I can attest that BP has never been involved than any of the, you know, planning or direction of the research.
David Uhlmann: Well, and this is clearly, you know, putting on my former Justice Department hat for a moment, this is clearly something that needs to be on their radar screen, I hope it is.
Al Franzblau: The Justice Department?
David Uhlmann: The Justice Department because they'll do a lot of things with the Gulf oil spill. I mean they've already brought a civil suit. I think they're going to eventually criminally prosecute BP. There's going to be billions of dollars in penalties paid by BP and the other companies involved. There's a very large what's called natural resource damage claim that will be paid by BP and the other companies involved. In other words, you know, the government will put a price tag on the harm to the environment and the companies will pay that price. Well, it sounds like we don't know what the public health price tag is, but we at least have some sense that there's a price tag on figuring out what the public health effects are and they'd be in the hundreds of millions of dollars and I don't see any reason why that shouldn't be part of the equation too. And, you know, it's great that BP has already made the gift that they've made. They should make a payment and a very large payment to fund any necessary public health studies going forward.
Andrew Maynard: I just want to clarify something. We actually had a question over Twitter, somebody asking-- Doesn't federal law set a liability cap of 75 million for BP?
David Uhlmann: Well, it does in the first instance. So what federal law says when you have an oil spill, and this federal law enacted after the Exxon Valdez tragedy 20 years ago. Federal Law says you're responsible for all the cleanup costs. So BP and its partners--you don't hear so much about its partners. It had two large corporate partners, Anadarko and Mitsui, and collectively those three companies are responsible for all of the cleanup costs. So the only one of those companies has actually paid anything and that's BP. So side issue, but Anadarko and Mitsui haven't been very good partners. They are not paying. And so BP, Anadarko and Mitsui are going to make a lot of lawyers rich fighting over who has to pay for the cleanup. But that's unlimited. Under the law, natural resource damages, economic damages, the public health effects we're talking about, those are capped, and they're capped at 75 million which is an extraordinarily low number for a spill of this magnitude. But BP early on said it would not invoke the cap, that it would agree to pay well beyond the cap and of course, BP set aside 20 billion dollars to pay victims of the spill and some of that money could go toward the studies that we're talking about presumably.
Andrew Maynard: Yeah.
David Uhlmann: And the law does have some outs. So if there were violations of legal duties, which there clearly were here, that cap may be gone legally anyway even if BP hadn't voluntarily agreed to waive it. But this is an example of what I was talking about earlier when I said, you know, we need to just think about changes both in our law and how we do things in our society to try and prevent spills like this from happening in the future, one of the changes we need is a change to that liability cap.
Andrew Maynard: Right.
David Uhlmann: And, you know, where is our congress? They took up legislation on this subject last summer, it did not pass and I just suggest that the prospects for passing have gotten a lot worse.
[ Laughter ]
Andrew Maynard: Let's take another question. Remember to say who you are.
[Audience- Nriagu:] I'm Jerome Nriagu, I'm in School of Public Health. First of all a small correction. Somebody said that the Gulf spill was the worst oil spill in the world. That's not really true. We've had more oil spills in the Niger Delta of Nigeria, actually. The total amount of spill actually exceeds what has happened in the Gulf by several orders of magnitude--by several fold.
David Uhlmann: You're correct. There are other regions in the world that have been badly damaged by oil spills. But the Gulf oil spill is the single worst accidental spill. The worst spill is actually from the Persian Gulf War. Saddam Hussein deliberately spilled even more oil into the Persian Gulf.
Al Franzblau: Actually, there was a spill, a gusher in California in 1910.
David Uhlmann: On shore, right.
Al Franzblau: It was on shore, not a maritime spill, and it went uncontrolled for like 15 months and it spilled 2 or 3 times as much oil as the Gulf. It created an inland lake basically.
Andrew Maynard: Okay, so we need to qualify those answers.
[ Laughter ]
[Audience- Nriagu:] Ok so you may be aware of the fact that NIH is in the process of funding several centers to specifically look at the impacts of the oil spill on the community. And there in fact the focus is in trying to understand the behavior of the spill and the food chain and the dispersion in the environment. What does the oil break down into? I don't know how many centers are going to be funded but that's in the works. So I don't know, again. So that will--I know that would fit into what is being done by your group. Then my question then is, what has happened to all the oil? [ Laughter ] Well, nobody seems to know where it has all gone to.
[ Laughter ]
Andrew Maynard: Who wants to take that?
David Uhlmann: But that's a good question, you know. Yeah, I mean see, we have a little bit of an out-of-sight, out-of-mind problem here. The oil, the oil in the Gulf as Al pointed out, was a lighter crude. The waters on the gulf are warm.
Al Franzblau: A lot of bacterial action.
David Uhlmann: Exactly.
Al Franzblau: It's very different than Alaska 20 years ago where you had a cold climate, a heavier crude and not as much biologic activity because it's a cold climate. And so, things are--you can't draw direct analogies necessarily.
Andrew Maynard: It has been pointed out that 5,000 feet below the sea surface is very different from what happens at the sea surface. So my understanding is that there's still a question there as to whether there are pockets of oil or partially decomposed oil that we're unaware of and certainly there's been some evidence of some of the sediments of accumulating oil.
David Uhlmann: Well, I think--I mean yeah, there's sort of good news and bad news on this question. I mean the good news is that the spill itself, I mean it creates a slick the size of the state of South Carolina, so there's huge amount of oil in the Gulf and remember last summer we were worried that it could enter currents and come down through the Keys and up the East Coast and there were a lot of fears about the spill having effects far beyond the Gulf region and those fears weren't realized. So that's--I mean that's good news. I think the bad news is, which you're eluding to Andrew, which is this is an awful lot of oil to have decomposing or disappearing from sight in the Gulf. And it may have disappeared from sight, but, you know, certainly these people in this room know in the School of Public Health, the fact that something isn't visible doesn't mean it's not harmful. And that's the question.
Richard Kwok: Well, I think that's also not only the oil but also the dispersants. So I think the dispersants, when they're injecting it at the wellhead 5,000 feet below the water, I mean it did its job, it dispersed the oil but then where did it all go and I think that--
Andrew Maynard: Right, right.
Richard Kwok: And so, there's a combination of the oil and then also the dispersants so I think is our concern.
Al Franzblau: I think one reason we don't know enough are a lot right now is that both the government and BP and other entities are actually doing a lot of environmental sampling but the reason a lot of that isn't becoming public just yet is because of the litigation that is looming and they know there's going to be a fight. And so, they're sort of gathering information and at some point, I presume, there's going to be a lot of data that's spilled out as discovery proceeds.
Andrew Maynard: Yup. Another question.
Audience - Pryor: I'm Ceci Pryor. I was wondering, is there any reconsideration about safety going on considering we're having all these dolphins and turtles washing up on shores in abnormal numbers?
Andrew Maynard: Anybody know about the sea life washing up?
David Uhlmann: I mean--and you know, you're right. There is--it's another area of unknown. So that's sort of a subset when I talk about the fact that we don't know the ecological effects, the long-term ecological effects. We also don't know the short-term ecological effects. We know a lot of birds died last summer. We know there were effects on aquatic life. There are a lot of endangered species in the Gulf that we know were affected but we can add that to the list. I mean when we talk about what we don't know, we don't know the public health effects, we don't know the environmental effects, we don't know--yeah, we don't know the economic effects even. I mean there's so much we don't know here and that's actually one of the challenges. I mean Al mentions the legal system and the legal system does sometimes get in the way of information being shared.
But one of the challenges for the legal system is that the legal system has to, in relatively short order, put a price tag on all of this and impose a liability. And a big challenge is, you know, how do you impose liability and make sure that the responsible companies pay for the damage they've done in a situation where there's so much uncertainty.
Richard Kwok: I think NOAA is doing a study about the dolphins and the sea life. And so--they're trying to address those.
Andrew Maynard: Right. Were you thinking in terms of them being indicative of something not being right in the ecosystem still?
Audience - Pryor: Well, I guess there have been some studies and obviously I can't cite anything but that say that this is an abnormal number that correlates to more that haven't even washed up that we don't even know about and that relates back to the oil spill. It's not something that, there's a certain amount of dolphins that die every year, there's baby dolphins that are apparently dying, sea turtles, just anecdotally, people are finding far more sea turtles and these are endangered animals too that are dying. And so, I was just wondering if they had found that there's something more going on in the water than originally thought?
David Uhlmann: Well, Richard mentioned NOAA, the National Oceanic and Atmospheric Administration, they are charged with doing what's called the natural resource damage assessment and it's a three-phase process. First they have to establish a baseline, you know, what were the conditions on the Gulf before the spill? And you know, one of the unfortunate realities is the conditions on the Gulf before the spill weren't exactly picture perfect. This was not a pristine ecosystem. This was an ecosystem badly damaged by human activity over the years. But they need to establish that baseline, then the second phase is they need to determine what's the harm and what's the damage that's been done to the ecosystem, which takes into account what you're talking about. And then the third phase, and maybe the most difficult, is they need to figure out how to make it right, how to get it back to where it was. And they need to put a price tag on it, and then the companies involved, they're supposed to pay that price tag. That would be the subject of litigation or at least negotiation. And so, very complicated involved process and one that has to take into account what we're talking about, at least from an ecological standpoint, the fact that we may not know for a long time what the full impacts were.
[Audience-Pryor:] Thank you.
Andrew Maynard: Another question, and then time is flying on, so we're going have to wrap up.
Audience: Hi there. I'm from the Department of Epidemiology here. I just want to say this is a great panel, great discussion of very important issues. I was curious about the actual oil rigs and I know there's been discussion about starting oil drilling in the Gulf. I heard this through news reports. I was wondering if there's been any policy or regulation changes in terms of ensuring oil rig safety given what's happened?
David Uhlmann: Oil drilling has resumed on the Gulf. There was a moratorium imposed on rigging--on drilling after the spill. Interestingly, the Gulf Coast rose up in great protest.
[ Laughter ]
Andrew Maynard: Right.
David Uhlmann: The coast that had been so badly damaged by this spill was very upset about the moratorium because the drilling is such a central part of their economy.
Al Franzblau: Right.
David Uhlmann: And they're now drilling again on the Gulf, which isn't great news. I mean the one piece of good news there is that the government has imposed a whole new set of requirements, safety-oriented requirements, and we may eventually have some good rules governing off-shore drilling. We really had very few rules before the spill.
Al Franzblau: Well, there's also another sleeping issue here. I'm going to throw out some numbers, which are mostly made up but [ Laughter ] you know, they've been drilling in the Gulf for most of the century and the vast majority of the wells that have been drilled are inactive and they've been presumably capped off and somebody is responsible for them. There's actually a government agency that, in theory, overseas those--I don't know what you call them--dormant wells--
David Uhlmann: In theory.
Al Franzblau: In theory, right. And in fact, they've done almost nothing and you have these wells that, you know, if they're not gushing like this one but just leaking slowly and they're thousands or hundreds of feet, you don't know. And so, there's this enormous curtain that we haven't really looked behind. That is an interesting question.
Andrew Maynard: Right, right.
Margaret Kitt: I guess I could also add if you haven't looked at it, the Oil Commission Report to the President is actually a really interesting document. I mean you nor--I normally wouldn't recommend that as good reading material [ Laughter ] but it is very interesting and I think it gives you a real good perspective of what the problems were and what the problems may continue to be if we don't put some fixes into place.
Andrew Maynard: Okay. We're almost out of time. This is what we're going to do. We're going to have--
Audience: Wasn't it we're supposed to go till 11:30?
Andrew Maynard: I would know. It was 11 o'clock.
Audience: But it says on the web.
Andrew Maynard: Does it say on the web 11:30?
Andrew Maynard: Oh, we made a mistake there. It's 11 o'clock I'm afraid. So we are wrapping up. So what I'm going to do is I'm going to ask each of you to talk for 30 seconds or so, you know, after this last question about where we go from here, what we've learned and what we need to learn in order to minimize impacts of things like this happening again. But before that, the last question here.
Audience - Christine: I'm Christine, I'm also with NIOSH and I was part of the response in Louisiana doing part of the health hazard evaluation and so, two questions really. One is I was part of reviewing some of the injury and illness surveillance through BP's clinics when they would see workers and when I reviewed it, I saw a lot of heat-related issues as well as some injury and perhaps some illness or symptoms related to contact with the oil in volunteers, so wild life rehabilitation volunteers. So I'm wondering if that's also--are those folks part of--will be part of this perspective study and then the other--
Richard Kwok: You mean the volunteers?
Audience - Christine: I'm sorry?
Richard Kwok: You mean the volunteers who helped you out?
Audience - Christine: The volunteers, right.
Richard Kwok: Okay.
Audience - Christine: And then the second question really quick, is another thing I observed on the barges when we were doing our surveillance for sampling, as well as sort of near the main BP center, is quite a bit of smoking. So I would say that huge exposure with second-hand smoke in the cabs of the watercraft, as well as in these different barges. And I talked to workers and they said they have never been around so much smoke before in their lives. So it could be--you know, there were a lot of smokers and they may have been smoking before this response, but the exposure to second-hand smoke from to these other people who don't smoke I was concerned about and wondered how that's going to be incorporated in the study?
Richard Kwok: Again, I mean it's asking about the passive and active smoking and so, it's just with the numbers and miracle of statistics.
Andrew Maynard: Well that's a bit of a cop out
[ Laughter ]
Richard Kwok: But what we do ask about passive smoking in their home, whether or not occupationally and also during the event itself, if they're not smokers themselves. And so, we do have a battery of questions asking about smoking and then drinking as well.
Andrew Maynard: But it does raise some very interesting questions, unfortunately, we are out of time but it seems like this is a whole box that needs to be unpacked, how you sort of tease out the various different exposures in confounding factors in terms of understanding the health impacts.
Richard Kwok: I think the exposure assessment is probably going to be one of the most critical and most difficult parts of the GuLF Study. Especially doing it retrospectively and not having individual level information. We have a few with some of the HHEs that were performed in--you know, very, very few numbers of like industrial hygiene measurements, the air samples that were taken, but almost no biologic samples, no, you know, pre-medical exams before deployment. It's going to be very--it's very, very complicated. But we do try to ask a relatively comprehensive list of questions in terms of exposures and activities to try to characterize it as you can and then group these individuals into different job exposure matrices of what job they do perform and then assign an exposure to them. It's probably the state of the science as it is.
Andrew Maynard: Okay. Well, thank you. So let's wrap up and this is a topic I want to get to about 10 minutes ago, but failed miserably. So in just 2 or 3 sentences, we're going to start from you Al and come back this way, what do you think we've learned from what's happened over last 12 months and what do need to do differently to ensure that we don't see health impacts of the sort of impacts that we've been seeing over the last 12 months in the future?
Al Franzblau: I'm not sure how much yet we've learned about the health impacts because studies are ongoing. There have been a lot of industrial hygiene measurements as has been mentioned, but that hasn't really been put out there yet in a public way, in a published way to be digested, but there is information. I know there have been a lot of measurements and I'll be very curious to see what those are when they come out.
Andrew Maynard: So they're still on the learning process?
Al Franzblau: Yeah.
Andrew Maynard: David?
David Uhlmann: I would say two things. We need to, in the future--although starting now, we need to put as much energy and make as much investment in preventing spills like this from occurring as we already put into drilling. I mean a remarkable aspect of this whole tragedy is that these companies had an incredible technological ability to drill for oil miles beneath the surface of the ocean, but no ability to shut off a runaway well. It's--you know, we need some balance. We need both the ability to drill and the ability to prevent tragedies like this if a problem occurs. But then the other thing I'd suggest is we also need to take a collective societal look in the mirror. These companies are only out there drilling on the Gulf because we have an insatiable thirst for oil and until we quench that thirst and find other ways of meeting our energy needs, companies like BP are going to be engaged in ever bolder efforts to drill in ever more riskier places and tragedies like this may be hard to prevent.
Andrew Maynard: Great. Thanks. Richard?
Richard Kwok: Obviously, I think having a coordinated response during the response efforts to look at research I think was important. I think NIOSH and NIH are helping to implement some of those things and I think Mark can talk a little more about that. But right now, we are doing the best we can. We've moved, you know, many administrative and logistical hurdles to get into the field as quickly as we have. I don't know how familiar you are with epidemiologic studies, but they don't move quickly. Yeah. And so, to be able to be--from the start to now I think we-- there's a lot to be proud of, but we're doing the best we can and right now we don't know. And so, we're trying to be as broad-based as we can to collect as much information to inform the decision makers with real-time credible data.
Andrew Maynard: Great. Thanks. Margaret, just go ahead.
Margaret Kitt: Moving slightly away from the chronic effects, I think one of the things to highlight is the response phase and the successes that were achieved during the response phase and having that many occupational safety and health professionals in the Gulf during the response was really unique and I think having those folks there did provide some preventive measures and oversight of what was going on and making sure that personal protective equipment was being used, that everyday workplace hazards were being identified and hopefully corrected. So I think that that was a success of the response. And additionally, I'd add that, we were successful I think because--partially successful--because of the collaborative relationships we've developed through an interagency working group that I'd mentioned we'd been working on for several years, but that effort can't be put on the part of the agencies, different agencies, it has to be built into the incident command structure so that we have systems put in place to make sure that our worker safety and health practices are followed throughout in a systematic way and I think that's a challenge that we have.
Andrew Maynard: Great. Well, thank you very much. This is just the beginning of the conversation. There are loads of things that I would have loved to talk about that we didn't get to, but you can carry on the conversation on the website, www.umriskcenter.org/unplugged. And with that, thank you very much again, all of the panelists.
[ Applause ]