Firefighters still paying price for 9/11

Senior physician in Jerusalem finds that firefighers at much greater risk of "sarcoid-like" granulomatous pulmonary disease.

twin towers 9/11 248.88 (photo credit: AP)
twin towers 9/11 248.88
(photo credit: AP)
A lung specialist from Israel who went to examine firefighters who had been at the World Trade Center on 9/11 found that as many as eight in 10 had some respiratory disorder. Dr. Izbicki Gabriel, a senior physician at the pulmonary institute of Jerusalem's Shaare Zedek Medical Center, was with a team that examined firefighters and found widespread "sarcoid-like" granulomatous pulmonary disease. Their study, which appeared in the prestigious journal Chest, revealed a high incidence - five times more among the same population, compared to the 15 years before the terror attack - of the lung disease sarcoidosis. "Maybe the most important message is that most of the lung damage could have been avoided if the firefighters had worn masks. This is of course also important for Israeli firefighters, policemen, soldiers and others." Previous reports, they wrote, suggest that sarcoidosis - an inflammation that produces tiny lumps called granulomas because they look like grains of sand or sugar - occurs with abnormally high frequency in firefighters. "We sought to determine whether exposure to World Trade Center 'dust' during the collapse and rescue/recovery effort increased the incidence of sarcoidosis or sarcoid-like granulomatous pulmonary disease." On the basis of their study (comparing results of medical exams before the disaster with those afterward), the researchers identified 26 men who had developed lung disease as a result of their exposure to the "dust" from the collapse. Many of these also had symptoms of asthma. It was the first study of its kind describing lung disease in World Trade Center rescuers. "These results add new insights into the etiology of sarcoid-like granulomatous pulmonary disease and sarcoidosis, and provide increased attention to disease prevention and surveillance following environmental/occupational exposures," they concluded. So far, five of the firefighters have already qualified for permanent pulmonary disability benefits. ANTIBIOTICS FOR BABIES MAY INCREASE RISK OF ASTHMA Chest also recently published research indicating that children who receive antibiotics before their first birthday are significantly more likely to develop asthma by age seven. The risk for asthma doubled in children receiving antibiotics for nonrespiratory infections, as well as in children who received multiple antibiotic courses and who did not live with a dog during the first year (living with pets at a young age reduces allergy risks). "Antibiotics are prescribed mostly for respiratory tract infections, yet respiratory symptoms can be a sign of future asthma. This may make it difficult to attribute antibiotic use to asthma development," said lead author Dr. Anita Kozyrskyj, of the University of Manitoba. "Our study reported on antibiotic use in children being treated for nonrespiratory tract infections, which distinguishes the effect of the antibiotic." By using a prescription database, Dr. Kozyrskyj and colleagues from the University of Manitoba and McGill University in Montreal were able to monitor the antibiotic use of 13,116 children from birth to age seven, noting antibiotic use during the first year of life and presence of asthma at seven. The reason for antibiotic use was categorized as lower respiratory tract infection (bronchitis or pneumonia), upper respiratory tract infection (middle-ear infection or sinusitis), and nonrespiratory tract infection (urinary infections or impetigo). Children receiving more than four courses of antibiotics had 1.5 times the risk of asthma compared with children not receiving antibiotics. Children who received multiple antibiotic courses and who were born to women without a history of asthma were twice as likely to develop asthma than those not receiving antibiotics. Furthermore, the absence of a dog during the birth year doubled asthma risk among children taking multiple courses of antibiotics. "Dogs bring germs into the home, and it is thought that this exposure is required for the infant's immune system to develop normally. Other research has shown that the presence of a dog in early life protects against the development of asthma," said Kozyrskyj. "Exposure to germs is lower in the absence of a dog. The administration of an antibiotic may further reduce this exposure and increase the likelihood of asthma development." SCHOOL HEALTH SERVICES ARE SICK The High Court of Justice has ordered the Health Ministry to explain within 60 days how it will supply school health services and supervise them at levels set down by the National Health Insurance Law. The High Court issued a temporary restraining order recently in response to a lawsuit by the Israel Medical Association, which objects to the Treasury's policy of privatizing health services in the schools. In the beginning of February, the IMA appealed to the High Court against the Finance and Health Ministries' intention to privatize health services that had been provided by the government. A million children aged six to 14 have been entitled to health checkups, vaccinations and first aid by school nurses, but their numbers were decimated and eventually the Association for Public Health (a for-profit organization) was contracted to supply health services in schools. But the IMA was unhappy, arguing that services were cut back drastically compared to the scope of care set down in the law. The IMA also criticized the government for handing over a collapsing school health service to private interests, arguing that the state was recklessly abandoning its responsibility. The IMA charged that the current situation in the schools is a "catastrophe," as the percentage of pupils receiving the necessary vaccinations has plummeted, and the number of pupils for which each nurse is responsible has doubled. The number of available doctors has also plummetted. The IMA added that the private group hired to supply services "has no professional ability," and that its organizational know-how consists only of channeling salaries to workers. IMA chairman Dr. Yoram Blachar called the High Court's action a "real achievement for the public health system," adding that the court has obliged the Health Ministry to implement the National Health Insurance law of 1994 that requires health services to be provided in schools. He said he hoped the court would intervene and prevent the school health services from being privatized.