Rachel's Precaution Reporter #96

"Foresight and Precaution, in the News and in the World"

Wednesday, June 27, 2007.............Printer-friendly version
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Table of Contents...

Lawyer's Illness Spotlights An International Threat
  "CDC [federal Centers for Disease Control] is always going to
  exercise the 'precautionary principle,' that you take protective
  measures even though you may not be certain how protective they will
  be, or how much further they may reduce risk," he said.
Precaution Urged for Power Lines in Northern Ireland
  "In all spheres of human and animal medicine, there is unanimous
  agreement that prevention is the best form of cure."
Tempest in a Bottle
  Planned water bottling plant stirs fierce opposition in Valemont,
  British Columbia.
Activists: Herbicide Spraying a Risk
  "There have been studies that have shown that road salt and oil
  from roads can get into water supplies. Our concern is the same thing
  could happen with the herbicides. We're sort of practicing a
  precautionary principle. Is it really a risk they want to take at all
  if it could get into the water supply and cause all these problems?"
Activists Want More Public Participation in Risk Assessments
  Activists and environmental health experts are stepping up their
  long-standing demand for more public participation in EPA risk
  assessment decisions.


From: Fort Wayne (Indiana) Journal Gazette, Jun. 24, 2007
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By David Brown, Washington Post

The story of Andrew Speaker's infection with "extensively drug-
resistant" tuberculosis -- with its weird improbabilities and
misunderstood messages -- has provided a crash course in one of the
21st century's least recognized health threats.

The wandering, love-struck and tubercular lawyer accomplished in two
weeks what a small army of epidemiologists and advocates has not in a
decade: given drug-resistant TB a Paris-Hilton-like spot in the
popular consciousness. He has added "XDR-TB" to the vocabulary of
American households alongside pandemic flu, anthrax and SARS.

"TB is a weapon of mass destruction, with 2 million deaths a year,"
said Henry M. Blumberg, a TB expert at Emory University School of
Medicine in Atlanta. "It is a huge global public health problem, and
it usually gets ignored."

Speaker's story has struck chords that will resonate long after its
details are forgotten.

The case marks the latest revision of the world's evolving notion of
health risk -- and what to do about it. It illustrates what may be
necessary to fight epidemics that, unlike classical plagues of
history, can take decades to develop. The federal government's first
use of an "order of isolation" since 1963 also showed what a long arm
in a white coat is willing to do to prevent infections that probably
weren't going to happen anyway -- but would be catastrophic if they

Perhaps most important, the case shows what can happen when the
affluent precincts of the global village ignore what is happening in
the poorer ones.

That last point is the one that Richard E. Chaisson, an expert in
drug-resistant tuberculosis at Johns Hopkins University's Bloomberg
School of Public Health, hopes will not get lost.

The existence of XDR-TB in the lungs of a young, healthy Atlanta trial
lawyer is evidence that the world needs to do a lot better at finding,
treating and preventing tuberculosis in poor countries. That is where
most of this year's 8.9 million new cases will occur -- 424,000 of
them resistant to two drugs (multi-drug-resistant, or MDR) and 27,000
resistant to at least four (extensively drug-resistant, or XDR). They
are the direct result of inadequate treatment.

"I am concerned that what will happen is that a lot of money and
attention will be spent on homeland security issues, which have little
to do with tuberculosis control," Chaisson said. "I am worried that
the focus may be on biosecurity rather than on the problem itself."

What's urgently needed, he said, are tools for diagnosing TB and drug
resistance that don't require fancy laboratories, as well as drugs
both to treat the resistant cases and to make treatment of the regular
cases quicker.

The subtleties and contradictions of Speaker's case underscore the
challenge of tuberculosis.

The 31-year-old did not have any of the common risk factors for TB. He
was not homeless or a recent immigrant. He had not been in prison. He
was not poorly nourished or infected with the AIDS virus. Where he
caught TB is a mystery. It's possible he was infected last year while
visiting hospitals in Vietnam, where he did charity work with the
Rotary Club.

Whatever the source, his illness is the result of the unwitting
exposure of a healthy person to an ill one -- the very scenario that
health authorities in Fulton County, Ga., sought to prevent when they
told him not to fly to Europe for his long-planned wedding.

However, it was always a long shot that he would infect anyone else.

His case was "smear-negative" -- no organisms were visible when fluid
from his lungs was examined under a microscope (although clearly they
were in there because they grew out in lab culture). He felt well and
wasn't coughing, which is the way the bacteria spreads in most
"pulmonary," or lung-involved, cases. He had not infected his fiancee,
family members or co-workers. His physician -- and apparently also the
local health authorities -- did not think he needed to be isolated
while awaiting treatment.

Nevertheless, people like Speaker aren't harmless. In a study of five
years' worth of new TB cases in San Francisco, 17 percent were traced
by DNA fingerprinting to a "smear-negative" infected person. The
concern about air travel arose from studies in the 1990s showing that
TB patients occasionally infect other passengers on long flights, with
the people sitting within two rows of them at highest risk.

Despite the improbability of Speaker's infecting anyone else, the
consequence of such an event would be extreme, especially when tests
revealed his case was not only drug-resistant, but "extensively" so.
Only one-third of XDR-TB patients are cured; the rest die.

Such "low-probability/high-consequence" scenarios are among the
trickiest in medicine. It appears that Speaker concentrated on the
probabilities; public health authorities were more concerned with the

The latter was dramatically clear when the federal Centers for Disease
Control and Prevention tried to stop Speaker during his honeymoon in

A former CDC tuberculosis specialist working there notified Italian
health officials and determined that Spallanzani Hospital in Rome,
which has experience treating XDR-TB cases, had an isolation bed
available. Simultaneously, a CDC quarantine officer in Atlanta tracked
down Speaker and told him by phone to stay put.

Although Speaker's risk to others was almost certainly still small,
transmission of the infection at this point would have been
unforgivable. So unforgivable that the CDC didn't feel it was safe to
send one of its airplanes to get him because none had air-filtering
systems that would fully protect the crew.

"You can't be faulted if you take the most conservative approach. I
saw this in the anthrax days," said Eddy A. Bresnitz, New Jersey's
state epidemiologist, who helped direct the response to the 2001
bioterror attack that caused, among others, six cases of anthrax in
New Jersey postal workers.

"CDC is always going to exercise the 'precautionary principle,' that
you take protective measures even though you may not be certain how
protective they will be, or how much further they may reduce risk," he

But extreme caution can have unintended consequences.

The prospect of being hospitalized in Italy for an indeterminate
period clearly alarmed Speaker. He and his bride bolted -- back home,
where he'd been told he would have the best shot at a cure.

Exactly what was said before they made this decision isn't known. CDC
officials say they laid out options for getting him home.
Nevertheless, Speaker's action highlights how much the perceptions of
single patients can affect the public health.

"It may be that the most effective way to safeguard the health of the
public at large is to assure the person who is sick -- or, in this
case, the carrier -- that he will not be abandoned," said Johns
Hopkins bioethicist Nancy Kass.

Whether it was necessary to slap a detention order on Speaker soon
after he reentered the United States has become a subject of debate in
public health circles.

Some believe the action violated a principle enunciated in another
context by Louisiana State University legal scholar Edward P.
Richards: that "the state demonstrate that the action ordered is
intended to prevent harm in the future, not to punish for past
actions, and that the action is reasonably related to the public
health objective." They argue the detention order was punitive, as
Speaker agreed to go straight to a New York City hospital when a CDC
doctor reached him by phone soon after he reentered the United States
via Canada.

Others believe the handling of someone who had twice defied medical
advice was justified. Part of the reason, they argue, is that XDR-TB
can only be fought one case at a time.

Unlike pandemic flu or SARS, XDR-TB does not emerge explosively. It
cannot be stopped by halting or limiting the movement of whole
populations. Moreover, there is no vaccine that can be given to masses
of adults to prevent infection.

Instead, TB can be controlled only by the meticulous care of
individuals, who must take medicine -- often a daily handful of pills
-- for at least six months, and sometimes for as long as three years.
Those who quit taking the medication once they started feeling better
are responsible for the emergence of drug-resistant strains. Stopping
a TB epidemic requires the prolonged cooperation -- either willing or
enforced -- of every patient.

If every person with XDR-TB acted as Andrew Speaker did, the result
would be calamity on a global scale. His detention -- whether that was
the intent or not -- sent the world that message.


Copyright 2007 LexisNexis

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From: Belfast (Ireland) Telegraph, Jun. 22, 2007
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By Patrick McGinnity, Veterinary Surgeon, Keady

Jim Lennon (Write Back, June 15) is fully justified in raising serious
concerns about the proposed NIE [Northern Ireland Electric] cross-
border [powerline] interconnector.

I am amazed at the casual dismissal of such fears by NIE, especially
in light of a British Medical Journal report highlighting a clear link
between overhead power lines and childhood leukaemia (BMJ, Vol. 330,
June 4, 2005).

In all spheres of human and animal medicine, there is unanimous
agreement that prevention is the best form of cure.

Hence the precautionary principle was enshrined in the treaty of

The UK Government, as a signatory to this treaty, agreed to
incorporate this fundamental principle in its decision making

NIE's stance contravenes everything the precautionary principle set
out to achieve.

Their arrogant attitude is that, in the absence of absolute proof of
health risks, they should be allowed to erect overhead cables, even
though under-grounding is a much safer option. The precautionary
principle argues that the onus is on NIE to provide proof that high
voltage overhead power lines are absolutely safe and, if they cannot,
then it is their responsibility to eliminate the hazard or minimise
risk. NIE's attitude is all the more disappointing given that several
European neighbours have greater commitment to Maastricht.

If NIE value their customers' health and the picturesque Armagh/Tyrone
landscape, they will do the decent thing and put the power lines

Belgium and Denmark have already banned the construction of all new
overhead high voltage power lines.

NIE simply don't want to spend the cash on under-grounding. Such
penny-pinching is unacceptable where health is concerned.

Instead of working up to a standard like the Swedes, the Belgians and
the Danes, NIE seem content to work down to a price.

Copyright Independent News & Media

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From: TheTyee.ca (Vancouver, BC), Jun. 21, 2007
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By Francis Plourde

Residents of a small hamlet near the Alberta border will gather later
this month to protest what they say is an environmentally questionable
plan to build a second water bottling plant in the region surrounding
their town.

Jill Moore and Irvin Leroux approached the Valemount Village council
in January, hoping to have a piece of property rezoned for their
proposed Shining Mountain Springs bottling plant.

At the time, the two thought their timing was good. The town of about
1400 had recently lost its major employer, a lumber company, and their
project could create between 20-60 jobs in the area. What's more, the
couple says, their intentions are benevolent.

Moore and Leroux's land is located on a pristine source of water
flowing from the nearby Monashee glaciers. The two want to extract
groundwater to sell it to third world countries and use the profits to
finance water-related humanitarian projects.

"We want to provide water to countries that don't have access to
water," said Irvin Leroux in an interview with The Tyee. "We want to
be profitable and operate on a minimum amount of profit. And we want
to provide good, clean, environmentally-friendly jobs for the area."

But that hasn't convinced local residents, about 100 of whom showed up
at a recent meeting to object to the plan. Concerned locals also sent
109 protest form letters to the regional district of Fraser Fort
George in the weeks leading up to the meeting.

Most of those who object to the plant are concerned about potential
environmental side effects, including the impact on the health of the
local aquifer. Valemount already hosts one water bottling company,
Monashee Springs. That plant has been around for 17 years and extracts
about 38,000 litres of water per day from the ground. But while water
quality tests are done on a regular basis, no official evaluation of
the aquifer's health has been completed.

Long-time resident John Grogan objects to the planned plant and wants
the regional district to use the precautionary principle. "We take
precaution about things that we don't know enough about," he said.
"This proposal sounds like they are mining water."

Sparse regulations

But regulations governing groundwater in B.C. are sparse, as Chris
Wood wrote about last year in The Tyee. So there may be few grounds
for Valemount residents to object to the project.

New provisions for groundwater protection were added to the Water Act
in 2001. And a Ground Water Protection Regulation was put in place in
2004. The regulation, however, focuses on well construction standards
and ground water quality protection. It also only applies to large
projects according to a spokesman from the Ministry.

Small projects though, can still be pretty big. Under the current
legislation, an individual or a business can extract nearly six and a
half million litres of water per day -- or 75 litres per second -- and
still be considered "small." By comparison, the limit for a small
project in Ontario is just 50,000 litres per day.

The Shining Mountain Springs project has the potential to extract 2.7
million of litres of water per day, or the equivalent of an Olympic-
sized swimming pool, according to their website. As a small project
then, groundwater regulations would not apply. Nor would the owners
have to pay licensing fees.

Linda Nowlan is the co-author of Eau Canada, a book that assesses the
mismanagement of Canadian water. She says stricter regulations on
water extraction are needed. "It's a public resource, and private
companies are taking groundwater and selling it," she said. "The
province is not getting any funding from that, unlike in the forest
and mining industries, where there are related fees."

Ontario, for instance, recently passed legislation to charge water
bottlers, canning companies and other heavy commercial water users
$3.71 per million litres extracted. An environmental assessment would
also be required for new projects.

Industry booming

Shining Mountain Springs would be part of a growing trend in Canada.
The bottled water industry has doubled here in the last 10 years,
earning a $653 million profit in 2005 alone. Water sales today
represent six per cent of the beverage industry.

The latest figures for B.C are nearly a decade old, dating back to
1998. But even back then the industry was gulping 163 million litres
of H2O per year from the province. B.C. is the third largest producer
of bottled water in the country, right after Quebec and Ontario, where
regulations have already been put in place.

Michael Austin moved to Valemount about a year ago. He is appalled by
the lack of regulations and information on groundwater. "I've been
asking what was the impact [of the water bottling plant]. But nobody
seems to have this information," he said. "We should obtain more
independent information about our aquifer before another water
bottling plant is established in town."

Shining Mountains Springs currently has to submit its own
hydrogeological report the regional district before starting the
project. But Austin wants an independent third party expert to assess
and monitor the local aquifer.

"It looks like I could drill some wells, provide some hydrogeological
reports and get a license," he said. He adds that the hydrogeological
study alone is not enough and should be coupled with geomorphology,
ecology and climatology studies to assess the whole impact of the
plant in the area.

Regarding Austin's concerns, Leroux says they have to submit to
several regulations in terms of quality of the water in addition to
the hydrogeological report. He also says he can't meet with the
residents until the reports are written. "When we present our project,
they'll be able to ask their questions to our independent experts."

Leroux says he follows the Canadian Bottled Water Association's ethics
guidelines -- which are stricter than most Canadian legislation -- and
considers the storm of protest against his water bottling plant "out
of proportion."

The water needs of their plant, he says, will be even less than the
needs of the golf courses in the surrounding area. "Besides, I feel
there's a number of aquifers that run out the valley through there,"
he said. "We are based on one of these aquifers. Our water comes from
other sources."

But residents fear the impact climate change might have on the aquifer
in the long run. Since 1850, some 1300 glaciers have lost 25 to 75
percent of their mass, most of it occurring in the last 50 years.

For Leroux, though, that's no reason to stop his project. "If they are
concerned about their water disappearing in Valemount area, the rest
of the country has a problem," he said. "It will never dry up, not in
our lifetime."

'Excessive withdrawal'

World wide, criticism of the bottled water industry is growing. A
recent report by the Washington-based environmental group Worldwatch
Institute called the explosion of bottled water sales a "boom to the
industry but a bust for the environment."

"Excessive withdrawal of natural mineral or spring water to produce
bottled water has threatened local streams and groundwater, and the
product consumes significant amounts of energy in production and
shipping," wrote the report's authors. "Millions of tons of oil-
derived plastics, mostly polyethylene terephthalate (PET), are used to
make the water bottles, most of which are not recycled. Each year,
about 2 million tons of PET bottles end up in landfills in the United

In Canada, too, concern is rising. "It's pulling resources down the
drain. And we contribute a cradle of pollution to the environment,"
said Susan Howatt, national water campaigner at the Council of

Moore and Leroux don't share the Council of Canadians' point of view.
They say that individuals are responsible for their own water waste.
They consider their industry cleaner than many others, and stress
they'll use the profits to finance water-related projects in countries
that don't have access to water.

The Council of Canadians, however, has a hard time believing their
intentions. "I'm cynical enough to say that it's a marketing ploy,"
said Howatt.

Besides, she adds, Canada has less water than people think. The
country is often credited with 20 per cent of the world's drinkable
water resources. Yet, official records show that Canada's share is
actually much lower, down at 7 per cent.

According to Howatt, it's why there's no political pressure to create
a national regulation on water. "Our water is our own apathy. We have
this crazy notion that we have all the water in the world. That's
tragically false. We are all downstream of everything," she said.

Worried locals

Late last month, Valemount locals Kim and Tore Thorn joined a group of
other residents to send a letter to local and national politicians as
well as NGOs. In the letter was a call for a moratorium on groundwater
exports and a request for official positions on water bottling plants
and exports. The regional district says the letters will be considered
during the next council meeting. And, in response to the opposition,
the council of Valemount recently expressed second thoughts on the

But the town's mayor, Jeannette Townsend, said that she will wait for
the studies to take a decision. "We'll wait until we get all the
facts, and we'll take a decision then," she said.

Copyright 2003 -- 2007 thetyee.ca

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From: Milford Daily News (Milford, Mass.), Jun. 24, 2007
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By Amber Herring, Daily News staff

Bellingham, Mass. -- With toxic herbicide spraying on Interstate 495
scheduled for late summer, state and local officials are weighing in
on potential harm to local residents.

"There have been studies that have shown that road salt and oil from
roads can get into water supplies," said Dan Dilworth of the Toxics
Action Center in Boston. "Our concern is the same thing could happen
with the herbicides."

The Toxic Action Center is working to mobilize local groups to stop
spraying in their own town, said Dilworth.

The spraying will begin in August in targeted areas of I-495 in
Bellingham and Franklin that have been approved by the town's
Conservation Commission, said Erik Abell, a spokesman for the
Massachusetts Highway Department.

The spray is used to kill weeds on the side of high speed highways, so
workers won't be put at risk. Cutting them manually was the sole form
of weed control until 2004, said Abell.

"In 2004, they began using herbicides citing the danger that manual
labor posed to the workers and also the costs," said Dilworth.

Workers do the spraying from trucks, said Abell.

"The financial part we would just say is not worth the health risks.
It's not worth the money saved," said Dilworth.

"We're concerned that eventually they can contaminate the water and if
the residents drink the water -- there's all sorts of health problems
associated," said Dilworth.

Studies show that exposure to the active ingredient in Roundup, the
spray used by MassHighway in the past, can cause eye and skin
irritation, headaches, nausea, numbness, elevated blood pressure and
heart palpitations, said Dilworth.

Abell said there's a big difference between the amount of road salt
and spray used.

"Road salt is applied to far more locations because it's designed to
treat the road as a whole. You're dealing with a higher volume there,"
said Abell.

The herbicides are only used in certain "dangerous areas" -- which
up to about 1/2 to 1 percent of state roads, said Abell.

The town also knows the danger and reviews the targeted spray areas to
make sure it's not near the public water supply, said Conservation
Commission Chairman Clifford Matthews.

"They are limited to using this in a particular area where there's no
danger of contaminating the public water supply," said Matthews whose
board approved the spraying several years ago.

"They came to us saying can we do this or not, and it's our feeling
that they're entitled to do it," said Matthews.

MassHighway has sprayed the same areas every year since approval, said

If they changed it, the commission would call them back to review the
new plan, said Matthews.

"Every few years, we'll touch base with them," said Matthews.

MassHighway also works in a controlled environment when spraying, said

"If it's too windy outside we won't go out and spray. We operate in a
controlled environment so not only is the application done as safely
as possible, but we prevent it from drifting into other areas," said

Toxic Action Center understands the workers are being careful, but
it's better to be safe than sorry, said Dilworth.

"We're sort of practicing a precautionary principle. Is it really a
risk they want to take at all if it could get into the water supply
and cause all these problems?" said Dilworth.

The public comment period held by the Department of Agriculture
Resources begins June 25 and closes Aug. 9, said Abell.

Concerned residents could contact the Board of Health or Conservation
Commission, said Dilworth.

Amber Herring may be reached at aherring@cnc.com or 508-634-7546.

Copyright 2006-2007 GateHouse Media, Inc.

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From: Risk Policy Report, Jun. 26, 2007
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Activists and environmental health experts are stepping up their long-
standing demand for more public participation in EPA risk assessment
decisions, urging a National Academy of Sciences (NAS) panel that is
developing a report on improving risk assessment practices to include
a strong recommendation for enhancing the affected public's role in
agency risk assessment and mitigation decisions.

Among other changes activists seek is EPA involving the public early
in the processes of deciding what issues should be addressed in agency
site-specific risk assessments.

The latest call for more public participation in risk decisions echoes
recommendations made in a 1996 NAS report, Understanding Risk:
Informing Decisions in a Democratic Society, which found that
implementing risk decisions can be difficult if federal agencies do
not involve stakeholders in the process. For instance, the report
noted that chemical producers can be relied on to participate in risk
assessment processes and debates, but "representatives of the more
general public or [activist] groups cannot, perhaps because of lack of
resources or limited expertise." The report concluded, "Ways to
broaden participation in these exercises should be explored."

That suggestion is being aggressively touted by environmentalists and
academic experts as the current NAS panel continues its work. For
instance, at a June 11 meeting of the panel in Washington, DC,
Jennifer Sass of the Natural Resources Defense Council said following
the 1996 recommendation "would go a long way" toward restoring public
confidence in EPA risk assessment and regulatory decisions, which she
argued has eroded over the years.

"Communities hate risk assessment" as it is currently practiced at
EPA, she told the panel, citing as an example a New York City group
called West Harlem Action whose representatives argued at a public
forum earlier this year that "communities feel there are really smart
technical people out there who don't come and breathe the air in
Harlem or drink the water.... They look at mice instead of people."
Communities resist "having to live with regulatory decisions" without
ever meeting or consulting with risk assessors or regulators, she

A West Harlem Action source did not respond to requests for comment.

At the meeting, panel chair Thomas Burke of Johns Hopkins University
asked Sass whether risk assessment "is running the risk of being
irrelevant" to real-world environmental health issues and how it could
respond to that potential problem. Sass said her concern is that "this
panel gets it" on the need for public participation, just as the 1996
panel ultimately promoted the idea in its report, "but how will EPA
implement it?" She argued the agency "has failed almost willfully to
engage public participation," for instance on assessing the risks of
organophosphate pesticides.

Sass' comments closely track with presentations to the panel earlier
this year by Amy Kyle of the University of California (UC) at Berkeley
and Nicholas Ashford of the Massachusetts Institute of Technology
(Risk Policy Report, April 24, p1). For instance, Kyle said EPA's
definition of risk assessment should encompass potential risks to
whole communities.

"Risk assessment needs to be informed by a public problem paradigm,
not just using the same [study] model every time," Kyle said at the
April 17 meeting. "The audience isn't just agencies" but includes the
public being protected by regulations, she said, adding that such work
could, for instance, support decisions by communities as well as
individuals "on safer, less toxic products."

She argued that "at the heart of this is the 'My way or the highway'
attitude from the risk assessment community, the idea that if you
don't do it my way nothing else you do is scientific."

NAS panel member Thomas McKone, also of UC Berkeley, asked Kyle at
that meeting whether EPA would be the right agency to do the kind of
work she proposed. "I'm not saying EPA can do all of this," she
responded, "but thinking about how to do it could be beneficial."
Ashford agreed with Kyle's assessment, saying, "When you talk to a
community you tell them about risk assessment and uncertainty and so
on and then someone [from the community] says, 'Does that plant need
to be there? Does it need to do what it's doing the way it's doing
it?' Well, that's an embarrassing question." It is also a question
toxicologists aren't equipped to answer, Ashford said.

Sass said at the June 11 meeting that more complete public
participation in risk decisions is desirable for the scientific
community and would not result in anti-industry bias. "People in
fenceline communities [near industrial sites] don't want those
businesses shut down. They work at the sites they live near," she
said. She pointed out, however, that occupational exposures "are some
of the highest" of any scenario and urged the panel to consider that
factor in making its recommendations.

Panel member Adam Finkel of the University of Medicine and Dentistry
of New Jersey concurred, saying, "One place where not a lot of data is
gathered is the workplace, and it's not going to happen if you rely
on" the Occupational Safety & Health Administration or the National
Institute of Occupational Safety & Health. "EPA could lend a helping
hand," he said.

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  Rachel's Precaution Reporter offers news, views and practical
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