Investigating illness clusters: Is state doing enough?

State health officials have pinpointed areas in Maine where the incidence of 22 diseases appears to be significantly higher than in other places. Each disease can have links to environmental and occupational exposure to toxic substances.

So far the data, which is taken from hospital discharge reports, cancer diagnoses reports and death certificates, hasn’t been used for anything because it hasn’t been verified, and nobody has decided what it means.

Critics from such groups as the Maine Lung Association and the Maine Labor Group on Health say the state isn’t doing enough to check out apparent illness clusters. State officials say they are doing all they can within manpower and legal limits.

“We have been moving as quickly as we can with the staff and resources available to us,” Dr. Lani Graham, director of the Bureau of Health, said in a letter to the Maine Labor Group on Health.

The raw statistics mean little. They can be affected by a wide variety of factors besides the environment, including the extent to which doctors hospitalize people for different diseases, and the age and personal habits of residents in an area.

Some of the statistics may be unreliable. For example, there appear to have been nine leukemia cases between 1984 and 1986 in the Rumford area if one consults hospital discharge rates, but only three if one consults the cancer registry.

State officials do not have the authority to check the actual hospital records to see if reports of cases are accurate, said Greg Bogdan, state environmental health director.

The chronic-disease report released in November was part of a joint effort by the Department of Human Services, which contains Graham’s bureau, and the Maine Health Care Finance Commission. It merged data for 1984 to 1986, and noted areas with significantly higher incidence of diseases.

For example, 20 percent of male cases of bladder cancer are caused by exposure to workplace chemicals, according to one textbook. High rates of the disease were found in Knox and Lincoln counties, and in the Waldoboro, Falmouth and Scarborough areas.

Another disease, aplastic anemia, is known to be caused by benzene, cellosolves and other chemicals as well as by medicines, radiation and insecticides. High rates have been spotted in Oxford County and the towns of Kennebunk, Westbrook, Norway, Bethel and Rumford.

Eleven of the 20 disease categories are lung-related, which can be closely connected to occupational exposure to chemicals and asbestos, as well as smoking habits. High incidences of lung cancer were reported in five counties — Cumberland, Lincoln, Oxford, Sagadahoc and Washington — as well as around seven communities — Scarborough, Portland, Bath, Damariscotta, Bethel, Rumford and Machias.

The state wasn’t moving fast enough, so the Maine Labor Group on Health hired its own epidemiologist to study the high rate of aplastic anemia in the Rumford area, said Diana White, the group’s executive director. She said she fears a link between the disease and chemicals used by workers at the Boise Cascade mill in Rumford.

A study also has been initiated by the Maine Lung Association in conjunction with the University of Southern Maine in an effort to develop a profile of communities with significantly high and low levels of respiratory disease, said Edward Miller, executive director of the association.

Miller said he’s dissatisfied with the state’s pace in studying and interpreting its data.

“Part of the problem is that they have yet to really describe a protocol for how they are going to address areas of concern that come from the data they are collecting,” said Miller. “The bureau is collecting information … but what is their plan for dealing with this issue?”

He asked, “Are the people who are collecting and analyzing the data the same people who have the skills to intervene and do something about what the data shows?”

Bogdan says DHS has a procedure for dealing with cancer clusters, but without authority to examine hospital records filed with the state it can’t be implemented. A remedy, he said, lies in LD 2070, which would give DHS access to confidential data in state agencies, and lift liability for civil damages from doctors and hospitals for such investigations. The bill has been passed and is awaiting Gov. John R. McKernan’s signature.