April 20 marks the four-year "anniversary" of the worst oil spill this country has ever seen. The Deepwater Horizon rig exploded and sank, killing 11 rig workers and subsequently, unleashing millions of gallons of crude into the Gulf of Mexico.
Areas around Barataria Bay and Grand Isle, La. were particularly hard hit, but they weren't the only affected areas. Moreover, thousands of birds, other wildlife and marine life including dolphins perished, were oiled, sickened and overall left in distress. The effects on the area resonate now, which is only a shock to those either unfamiliar with garish oil spills or unwilling to accept the truth.
In the days following the "spill", BP, apparently colluding with the US Government, doused a horrific amount of a deadly dispersant in the affected areas. Called "Corexit", the cutesy name belies the sickening effects it brings to all it touches. On background, an environmentalist working in the area explained to me last year that they were, essentially, damned if they did, and damned if they didn't, but chose the lesser of two ills.
That remains to be seen as the National Institutes of Health continues its 10-year "GuLF" study of BP spill health effects, from those most affected out on the Vessels of Opportunity boat that included BP-hired personnel trying to contain the spill, to residents in the line of fire, such as around Barataria Bay.
Dr. Dale Sandler, NIH epidemiologist and principal investigator for the $19 million BP-funded study, spoke to this examiner a few days ago. We had also had a conversation three years ago when the study - which stands for "Gulf long-term followup" - kicked off.
Following is an edited transcript of our conversation.
What have been the most surprising findings from the past three years?
I don’t have any surprising findings. There are no surprising findings to date. We are looking at…preliminary stages – how people are feeling one to two years after the spill – but the goal is to look at long-term effects.
We're looking at…what we might see based on other disasters and previous oil spills – [for example] we see increased depression and anxiety among people who worked on the oil spill as well as people in the affected region, and we are just now starting to look at other things we'd been concerned about like respiratory symptoms.
In March, 2011 you told me that your first goal was to “I.D. potential associations on a more understandable level or globally, [such as] certain work tasks or [whether one was] involved in opportunities to [be] exposed to chemicals. If we can drudge [sic] links between what they [the volunteers in the study] did and their health ...and what they are reporting, whether there are other diseases, then as we delve further into the project we can can look at influences of 'underlying factors' [in a person's health].
Genetic susceptibility might influence how responsive somebody is to chemicals so we will be looking into that.”
Have you learned anything specific about genetic susceptibility during these three years? Also, if someone is exposed to deadly chemicals, such as Corexit, really how important is it to parse out “genetics” in the equation? Corexit has been proven to be very toxic and even deadly.
We have not really tackled that piece of the study yet. We’ve just started on the first piece – 11,000 home visits – [and there are] lots of people to study – and we are just starting to look at [criteria such as] people who live in the Gulf versus don’t; who worked on the oil spill versus not; and we are .... waiting on exposure experts, such as hygenists and chemical experts, to pull together measurement data taken during the course of the spill so we can really “ID” [what happened to these people].
We can “guess” if it was dirty [and toxic to work on the spill] but if we have measurement data, we can say there was higher exposure. But we are a few months away from doing that.
We collected people's blood and we are beginning to extract DNA from blood, so over the next year or so we will do more focused investigation(s).
How is it, or is it, possible to learn anything about people's anxiety or depression from their blood? And from what I've read, you have started by focusing on the mental health aspect of this study.
There are no biomarkers for depression and anxiety, but there are for stress, and we plan to use [those biomarkers]. ...One thing most different [in terms of parsing out the stressful effects of the spill] for people in [the Gulf] community is that we can’t use blood samples we collected one to two years after the spill.
Chemicals related to oil, like benzene, only last in the blood for less than 24 hours, so in the absence of an ongoing oil spill …anything we measure is a result of other [events] …daily oil spills, general air pollution, cigarette smoking, most importantly, [which] exposes people to benzene.
I understand that mental health was your first focus. Why is this/was this?
We know from previous oil spills and other natural and environmental disasters that the entire exposure is disruptive in the community, and mental health effects are the first things you see. After the EXXON Valdez [oil spill], and other spills, after Three Mile Island [nuclear meltdown], World Trade [9-11], one of the most salient, obvious things was increases in depression and PTSD, and these mental health impacts impact the perception of health and actual physical health.
One of my concerns and observations is that many residents of the Gulf do not have or have adequate health insurance. But this study is part of the multi-million-dollar BP settlement right? Even so, what’s the guarantee that visits are covered and objective?
There is no cost for participating and it’s really about research. Clinical exams focus on research, do reports … screen and do things that are useful… On the next level of exams, we will let them [sick Gulf residents] know if they have problems with lung function or need a workup for diabetes, [for example].
Money we got early on was part of the gift to the NIH from BP and was separate from any settlement. Most recent settlement funding [involved]…piecing out …[where there was a] need for people exposed to chemicals [to receive attention, and that will factor in] as we begin the next round of clinical exams. As we I.D. people in need of more [concentrated services]…we can connect them through the network, but it's [the GuLF study funding from BP] entirely separate [from the funds going directly to Gulf claimants, through the Plaintiffs' Steering Committee] .
How are are you accurately assessing results? Mental health, in particular, can be very tricky to assess.
It is important that we are not making a clinical diagnosis, but we do use standardized scales, questionnaires that are used in other settings …you might ask somebody, [for example] twelve questions…[and from that, determine] that these people who score the worst are the most likely to, if you examine them, if a psychologist saw them, would actually make that clinical diagnosis [of PTSD or another mental health diagnosis]. We will do more extensive testing using these and additional structured scales. Some people we are interviewing every six months, to look at changes over time, then clinical exams done in person, using standardized testing using structured [questionnaires]…
People who score high will be given information about where they could [go to see someone to help them.] …We are identifying all of the resources in the community, state and local government resources funded thru the BP settlement, where people can go if they qualify and receive care for free or at a reduced cost.
NIH does not pay for this. Administration of care [is paid for either by the individual or at a reduced rate or by BP, at certain hospitals/clinics.]
In your study, have you been able to draw a delineation between what are oil spill health effects and what was/is caused/being caused by Corexit?
This is our goal. We have devoted tremendous resources to characterize exposures. We do this by pulling together external data… measurements in the breathing zone for people standing over the fire [from the Deepwater Horizon rig], and doing certain cleanup tasks. And what we are really hoping is to sort this out, which is, in part, why the study is so large. We are distinguishing from those who lived there and did a specific job, from [those who did not live there or perform direct jobs related to the spill.]
We need to collect information about exposure to the oil, link it to a job and a task at the time of the spill, and apply a number to it – a scale from most exposed to least exposed. ... And we are doing this without benefit of a biomarker.
When you do a study like this you think, 'Oh, if I only had a biomarker, I could really zero in. But the same problem where we can’t know and measure blood today [and how it relates to a few years back, at the time of the spill] exists when studying day-to-day volatile compounds. In some ways, having a biomarker would be a distraction.
Tomorrow: Dr. Sandler on how the next stage of the GuLF study will proceed. (Click here to read that article.)
Bold marks and hyperlinks are those of the examiner's.