Health Agencies Under Scrutiny

The Agency for Toxic Substances & Disease Registry (ATSDR), a little-known organization with the mission of assessing human exposures to toxic substances, and its sister agency, the National Center for Environmental Health (NCEH), are in the hot seat. Both agencies, which are part of the Centers for Disease Control & Prevention, are being closely watched by Congress and its investigative arm, the Government Accountability Office (GAO), because of claims that they have consistently used unsound science and incomplete data to make crucial public health decisions.

In the House of Representatives, the Science & Technology Committee’s Investigations & Oversight Subcommittee has been scrutinizing ATSDR for several years. It has now expanded its probe to include both ATSDR and NCEH. At a hearing last month, subcommittee members examined problems with ATSDR’s policies and procedures for preparing environmental health assessments. They also highlighted serious flaws in an article coauthored by NCEH staff in 2004, which claimed that high levels of lead in Washington, D.C., drinking water posed no risk to children’s health.

The hearing was the third one held by the subcommittee in two years that focused on ATSDR. In April 2008, it examined the agency’s flawed health assessment of formaldehyde in trailers provided to victims of Hurricane Katrina. And last year, it found problems with ATSDR’s health assessments of contaminants at the Marine Corps’ Camp LeJeune, in North Carolina; on Vieques Island, P.R.; and in Midlothian, Texas (C&EN, March 30, 2009, page 27).

“This subcommittee cannot possibly identify every mistaken evaluation, assessment, report, or article done by ATSDR or NCEH staff,” subcommittee Chairman Brad Miller (D-N.C.) said at the hearing. “CDC must take all necessary steps to set these offices on the right path.”

CDC has taken some steps already, Miller acknowledged. For example, the agency reassigned Howard Frumkin, former director of ATSDR and NCEH, to another position within CDC in January. But more changes are needed, Miller stressed.

He urged the agencies to stop “conducting studies designed to make it impossible to find a health problem.” Miller also suggested that the agencies disclose the limitations of incomplete, inaccurate, or irrelevant data; rigorously review study designs and final reports; and implement consistent policies and procedures.

As an example of the impact of systemic problems at CDC, Miller pointed to NCEH’s handling of lead in drinking water in Washington, D.C., in 2000–03. In 2004, NCEH scientists coauthored an article in CDC’s Morbidity & Mortality Weekly Report (MMWR) claiming that no children in their study were identified with blood lead levels greater than 10 µg/dL (2004, 53, 268).

CDC acknowledges that statements in its 2004 article were misleading and has since reanalyzed the data, including more complete information from 2003. The reanalysis, published in MMWR (2010, 59, 592), was released on the day of the subcommittee hearing. In the updated article, CDC writes that “children living in homes serviced by a lead water pipe were more than twice as likely as other D.C. children to have had a blood lead level ≥10 µg/dL.”

A subcommittee report, however, provides more complete data on blood lead levels of District residents during the crisis, calling CDC’s reanalysis into question. “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,” Miller said.

One of the reasons for such failures at ATSDR and NCEH is the lack of consistent policies and procedures, testified Cynthia A. Bascetta, director of health care at GAO. She raised concerns regarding three phases of ATSDR’s product preparation: initiating new work, developing the product, and reviewing and clearing the product for publication. “For all phases, we documented the lack of some critical controls needed to provide a reasonable assurance of product quality,” she noted.

Robin M. Ikeda, deputy director of CDC’s Office of Noncommunicable Diseases, Injury & Environmental Health, defended the agencies, telling lawmakers at the hearing that “several improvements are under way.” Ikeda oversees four centers at CDC, including ATSDR and NCEH.

In response to GAO’s recommendations, “ATSDR is working to strengthen our priority setting and project management to make them more explicit and consistent across the agency,” Ikeda noted. On a larger scale, ATSDR and NCEH launched the National Conversation on Public Health & Chemical Exposures in June 2009, she said. “This two-year project will identify strategies to better protect the public from harmful chemical exposures,” with input from government agencies, public health experts, and members of the public, she added.

But lawmakers and witnesses questioned the value of the project, saying it appears to be taking resources and energy away from any real reform efforts at ATSDR and NCEH.

Stephen Lester, science director at the environmental group Center for Health, Environment & Justice, told lawmakers that he is leery of working with ATSDR because of bad experiences he had with the agency in the early 1990s. ATSDR should “begin by looking back at the recommendations that came out of the work we did from 1990 to 1992,” he suggested. “Most of those recommendations were never implemented by the agency, and they are still applicable today.”