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Review of ATSDR‘s Great Lakes Report Drafts (Letter Report)
Review of ATSDR’s Great Lakes Report Drafts (Letter Report)
Committee to Review ATSDR's Great Lakes Reports
Board on Population Health and Public Health Practice
INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES
THE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu
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Review of ATSDR‘s Great Lakes Report Drafts (Letter Report)
THE NATIONAL ACADEMIES PRESS
500 Fifth Street, NW Washington, DC 20001
NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.
This study was supported by Contract 200-2005-13434, TO #11 between the National Academy of Sciences and Department of Health and Human Services. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.
Additional copies of this report are available from the
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For more information about the Institute of Medicine, visit the IOM home page at www.iom.edu.
Copyright 2008 by the National Academy of Sciences. All rights reserved.
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The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.
IOM (Institute of Medicine). 2008. Review of ATSDR’s Great Lakes Report Drafts (Letter Report). Washington, DC: The National Academies Press.
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Review of ATSDR‘s Great Lakes Report Drafts (Letter Report)
“Knowing is not enough; we must apply.
Willing is not enough; we must do.”
—Goethe
INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES
Advising the Nation. Improving Health.
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Review of ATSDR‘s Great Lakes Report Drafts (Letter Report)
THE NATIONAL ACADEMIES
Advisers to the Nation on Science, Engineering, and Medicine
The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.
The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering.
The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.
The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council.
www.national-academies.org
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Review of ATSDR‘s Great Lakes Report Drafts (Letter Report)
COMMITTEE TO REVIEW ATSDR’S GREAT LAKES REPORTS
ROBERT WALLACE (Chair), Irene Ensminger Stecher Professor of Epidemiology and Internal Medicine,
Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
JOHN C. BESLEY, Assistant Professor,
Science and Risk Communication, School of Journalism and Mass Communications, University of South Carolina, Columbia, South Carolina
EDMUND A.C. CROUCH, Senior Scientist,
Cambridge Environmental Inc., Cambridge, Massachusetts
FRANCESCA DOMINICI, Professor,
Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
MARION F. EHRICH, Professor,
Biomedical Sciences and Pathobiology, Virginia—Maryland Regional College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia
S. KATHARINE HAMMOND, Professor and Chair,
Environmental Health Sciences Division, School of Public Health, University of California, Berkeley, California
DAVID A. KALMAN, Professor and Chair,
Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington
SUSAN A. KORRICK, Assistant Professor of Medicine,
Channing Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
MARIE C. MCCORMICK, Sumner and Esther Feldberg Professor of Maternal and Child Health,
Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, Massachusetts
PATRICIA A. NOLAN, Adjunct Associate Professor of Community Health,
Department of Community Health, Warren Alpert Medical School, Brown University, Providence, Rhode Island
MARA SEELEY, Senior Toxicologist,
Gradient Corporation, Cambridge, Massachusetts
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Review of ATSDR‘s Great Lakes Report Drafts (Letter Report)
STAFF
Michelle C. Catlin, Study Director
Naoko Ishibe, Program Officer
Jennifer Saunders, Senior Program Associate
Rose Marie Martinez, Director,
Board on Population Health and Public Health Practice
Joseph Goodman, Senior Program Assistant
Norman Grossblatt, Senior Editor
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Review of ATSDR‘s Great Lakes Report Drafts (Letter Report)
REVIEWERS
This report has been reviewed in draft form by persons chosen for their diverse perspectives and technical expertise in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of the independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards of objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We thank the following for their review of this report:
John C. Bailar III, The University of Chicago, Professor Emeritus
Linda D. Cowan, College of Public Health, University of Oklahoma
Tom Gasiewicz, Department of Environmental Medicine, University of Rochester Medical Center
Lynne Haber, Toxicology Excellence for Risk Assessment
Shelley A. Hearne, Health and Human Services Program, The Pew Charitable Trusts
Barbara A. Knuth, College of Agriculture and Life Sciences, Cornell University
Robin Puett, South Carolina Cancer Prevention and Control Program, University of South Carolina
Joshua Sharfstein, Baltimore City Health Department, Baltimore, Maryland
Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations, nor did they see the final draft of the report before its release. The review of this report was overseen by Gilbert S. Omenn, Center for Computational Medicine and Biology, University of Michigan Medical School and Jonathan M. Samet, Bloomberg School of Public Health, Johns Hopkins University. Appointed by the National Research Council and the Institute of Medicine, they were responsible for making certain that an independent examination of the report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the author committee and the institution.
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Review of ATSDR‘s Great Lakes Report Drafts (Letter Report)
CONTENTS
COVER LETTER TO DR. JAMES STEPHENS
1
REVIEW OF ATSDR’S GREAT LAKES REPORT DRAFTS (LETTER REPORT)
7
Organization of This Letter Report
7
Background on ATSDR Drafts Evaluated
8
Overarching Comments on the Draft Reports
9
Purpose of the Report Drafts
11
Scope of Project and Literature Review
12
Appropriateness of Datasets, Scientific Quality of Data Analysis and Presentation, and Conclusions
13
Contaminant Data
13
Demographic Data
17
Health Data
18
Data Analysis
20
Presentation of the Information
21
Conclusions of Report Drafts
22
Responsiveness to Reviewers’ Comments on 2004 Report Draft
24
Validity of Directors’ Offices’ Concerns Regarding 2007 Report Draft
25
Responsiveness to Reviewers’ Comments on 2007 Report Draft
26
Scientific Soundness of 2008 Report Draft
26
Suggested Improvements and Other Committee Concerns
27
Conclusions
28
References
30
APPENDIX A
MAPS OF GREAT LAKES AREAS OF CONCERN
33
APPENDIX B
LETTER FROM IJC
37
APPENDIX C
MATERIALS RECEIVED FROM ATSDR
39
APPENDIX D
ABBREVIATIONS
40
Boxes and Figures
BOX 1
Statement of Task
7
BOX 2
Timeline of Events
10
BOX 3
Example of an Indirect Effect
12
BOX 4
Example of the Addition or Removal of Hazardous-Waste Sites Without Following the Criteria
13
BOX 5
Example of Conclusion That Was Not Justified by Report Contents
24
BOX 6
Example of Recommendation That Was Not Justified by Report Contents
24
FIGURE A-1
Great Lakes Areas of Concern
33
FIGURE A-2
Ashtabula River Area of Concern, Ohio
34
FIGURE A-3
Clinton River Area of Concern, Michigan
35
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