Dr's karmen homeotherapy

 PRESENTACION DE LA DRA . CARMEN M. COLON DE JORGE ANTE EL ATSDR (Agencia Federal de Sustancias Toxicas y Registro de Enfermedades)

Mas delante esta el "link " para ver el power point presentado por de la científica puertorriqueña en la consulta el CDC de Atlanta del 5-6 de  noviembre de 2009

La Dra. Colón de Jorge defendió sus investigaciones en 1999 cuando alertó a la ciudania de Puerto Rico de la contaminación con metales pesados en  infantes niños  y ancianos  en la isla de Vieques por los bombardeos en la práctica de la marina de los Estados Unidos .

para ver la presentación en

power point clic aquí

http://www.slideshare.net/naturopatia/naval-bombing-in-vieques" title="NAVAL BOMBING IN VIEQUES

Adelante la reacción de  la Dra. Colón de Jorge en al  resumen  de la consulta cientifica en el  comunicado de Prensa   publicado en el

NEW YORK TIMES 

Noviembre 13 del 2009 

(columna a la  derecha)

ATSDR (Agencia Federal de Sustancias  Toxicas y Enfermedades

To : ATSDR director Dr. Howard Frumkin

Dr. Carmen Colón de Jorge: A Fresh Look to the ATSDR's Fresh Look at Environmental Chemical Exposures on the Island of Vieques

Collaborates

Scientific Committee  of Licensed Naturopaths Association of Puerto Rico

John Ferrer Brooks M.D. Licensed Naturopath

Francisco Lopez Perez , B.A. Licensed Naturopath

Health Professional  for  Vieques

Re: ATSDR Biomonitoring at Vieques , Puerto Rico

Questions,Comments, Petitions,Justifications

ATSDR Biomonitoring  is defined  as a  " direct  measurement of people's exposure to toxic substances in the environment, conducted  by measuring the substances or their byproducts in blood, urine and sometimes hair". 

 First :Question, Comments,  Petitions  and Justification 

Question

Why sometimes hair?

Comments

1- Hair Element Analysis  is the principal  measuring  analysis for chronic intoxication of heavy metals .Naval bombing of Vieques for the past 60 years has generated the suspicion in 1998  that caused  proliferation of multiple chronic diseases.

 2- At the Cientific Consultation  on  november 5 and 6 of  2009 was demostrated that Hair Elements Analysis from  Doctor's Data,  a medicare  provider is a systematic and scientifically rigorous to demostrate chronic heavy metal endogenous intoxication.  

3-That  our findings  share with ATSDR  on  november 5 and 6 of 2009.  Also in the future it can be corroborated with FBI Hair Elements   Laboratories  Analysis.

Petitions

1-  We need  from ATSDR  5 hundred randon  Hair Elements  Analysis   from Doctor's Data (  a Medicare  Provider )  and 5  hundred comparable from  FBI Hair  Laboratories  to Vieques population that include  ages from  1 year old to 75 years ;  one hundred hair test for 1 to 12 years old , one hundred for 13 to  20 years, one hundred for 21 to 40 year, one hundred to 41 to 75 years and one hundred hair test for people with specific health conditions.  

2-  Additional ; we need  from ATSDR , 200 hundred comparable Hair Elements Analysis specific from Doctor's Data ( a Medicare  Provider )  and FBI Hair Laboratories  comparable from different  areas far away from the island of vieques  , including  two hundred test on the island of Culebra  ;  one  hundred random and  one  hundred to people with health conditions.

Justification

1-Is necessary    to evaluate  ten years  later  , Vieques health population that  worsend  in  chronic diseases and nutritional deficiences . Hair Elements  Analysis  comfirm  zinc inbalance , selenium and  lithium depleted . Is evident  that  the toxic metal affected the metabolism of mineral and oligoelements.  

2-Mercury  and Cadmiun immediately  displace zinc  and cooper from methionine. Also cooper and zinc are co -factor for  superoxidase dimutase and  cooper is  required for the syntesis of chatecholamines.

3-Zinc  is critical in healing  wounds, inmunologic  functions and metabolism of protein and nucleic  acid. Mercury interferes with metabolism of progesterone. It is clear that cysteine metabolim ; an essential amino acid is related to chronic heavy metal toxicity.  

4-Is extremely  important for  the ATSDR Fresh Look and the  good intention to a  systematic and scientifically rigorous biomonitoring program  to find out   chronic heavy metal intoxication and  nutritional status for posterior Viequenses  treatment diseases and of metal toxication.

Note#1: Attachment #1 February 21. 2001. Scientific Protocol to Determine Toxic Metals in Viequenses due to  Biological Exposure to Heavy Metal with an Addendum Proposed  Budget for Testing Protocol .

The protocol was prepared by  Dr.Carmen Colon  de Jorge and collaborates . The  protocol  Dr. Carmen  Colon de Jorge left  in hands of Dr. Robert Johnson  and Mrs. Maria Teran Mc Clever  from ATSDR when they were in Vieques. We never   received respond or any reaction from the ATSDR about the protocol. At the  Scientific Consultation  november 5 ,2009. Dr. Colon de Jorge talked to Maria Mc Clever and she said that the protocol is in the hands of the ATSDR .

Note #2: Attachment  #2 , Cysteine Metabolism and Metal Toxicity

David Quig,Ph.D.Vice Presiddent, Scientific  Support, Doctor'Data, Inc.

Second:Questions, Comments,  Petitions  and Justification 

Question

1 - Why the ATSDR  do not included  Fecal Elements Analysis  in the Fresh Look ?

Comments 

1- We presented  Milivi   "Perfect Crime ". We  presented  evidence of   two year old toddler that died from cancer  in Vieques  in  2000. This is extremely serious.  Heavy metals enter and accumulate in body tissue faster than the body’s detoxification.

2- Milivi  fecal Elements Analisis was 4 times ATSDR  oral ingestion , "Minimal Risk" in Uranium  and 50% Mercury over Doctor's  the Reference Average . Arsenic  0.666mg  ( ATSDR Minimal Risk is .oo5mg/kg /d) . Fecal Element  Analysis demostrated  that oral ingestion  have a direct relation  to fecal dry heces detoxification in one day excretion test. 

3-Additional we presented  an infant Fecal Elements Analysis with  only 18 moths old had 10 times  ATSDR  Uranium " "Minimal Risk" in the same condition of Milivi. This baby also had 0ver 2 oo % of aluminium  ( 750 mg/kg dry heces versus 130  Doctor's Data  Average  reference ), over 100% mercury  and  50% Nikel.  So that Fecal Element Analisis was an extremely  important  issue in Novenber  5, 2009 at the Scientific Consultation .

4- The Fecal Elements  Analysis provide coprehensive evaluation of enviromental exposure, acumulation and endogenous detoxification of  potentially toxic metal in  Milivi  and  the other children  that we did not get to discuss.  We discussed only Uranium but Milivi also had  high level of Mercury, Antimony, Arsenic and Nikel.

5- If  the ATSDR  Fresh Look does  not  include Fecal Elements investigation, that means,  sincerely  that we  lost  our time in the Cientific Consultation and no accountabillity   from  the  ATSDR in the biomonitoring and the compatibility  with our investigations..

Petitions

1- We need  at least from ATSDR  additional 0ne hundred Fecal Analysis , specific from Doctor's Data laboratories (  Medicare  Provider )  to 15  pregnant , 15 lacting mothers, 10 neonatal,  10  toddlers,  20 children and  20 adolecent that  were born and live  in Vieques at the moment of the sampling. One hundred  comparable Fecal Analysis  far away from Vieques, 25 at  Culebra and 25  at Fajardo, 25  at  Ceiba, 25  at Humacao.

 Justifications

1- The suspicion of teratogenicity  by heavy metal in Vieques.  A  deformed viequense , at 13 years old that had  100% cadmiun (1mg/kg dry wet heces) over  Doctor's Data reference averages  0.47 mg/ mg/kg ) Fecal Analysis and over 200%  Mercury,% Nikel, 50% Copper.

                                                                          2- 18 month old infant 100% mercury ( .o41 mg/kg dry wet heces  vs reference average 0.2 w/o  value for no amalgam pacient.

Third:Questions, Comments,  Petitions  and Justification 

Question

1- Is ATSDR  measuring  of the substances  an their byproducts in the Viequenses  urine  is  specific for chronic  heavy metal intoxication?

Comment

1 - Chronic heavy metal intoxication cannot be find in  regular toxic metal  urine test, but is good for acute heavy metal  intoxication. The chronic low level exposure is consistent  with the viequenses symptons and diseases.

2-The  Cysteine Metabolism Test , demostrates that metals sulfhydryl-reactive group metals  (mercury, cadmium, lead, arsenic )  affect the formation of co-enzyne-A , necessary in the metabolism of the cell. Glutatione , a detoxicating peptide combine to heavy metal ions reactive to sulfhydryl.

3-In the other  hand Cystein intervenes in the endognous detoxication mechanisms of the body.The exposition to heavy metal received to sulfhydryl group.

Petitions

1-  We need from  ATSDR 0ne hundred  urine  testing confirmation for chronic metal intoxication . Amino acid Urine Analysis  specific from Doctor's Data  a  medicare Provider .

a) Cysteine  Analysis  for  Chronic Heavy Metal Intoxications  and Nutritional Factors doesn't  need provoked urine elements because this test is  performed  with the  intention to compare  heavy metal findings  in Fecal and hair  Analisis and Nutritional factors in specific pathologicals or health conditions.

b) Toxic metal affect the metabolism of minerals and interrup the biochemical processes causing symtoms of chronic fatique, neurophathys,  neural disorders, depression , musculskeletal pain and other persistent diseases in viequenses.

 c)  Is  extremely  important for a   systematic and scientifically rigorous biomonitoring program to find out  the substances  in   chronic heavy metal intoxication in the viequenses diseases. .  

Justifications

1-Viequeses chronic intoxication can be detected    with a Cysteine  Aminoacid Urine Test.

2-Viequeses have  Common Symptoms Associated with Sulfhydryl-Reactive Metal Toxicity , like chronic fatigue; depression ,cardiovascular diseases, hypertension ,  fatigue,  muscle and joint pain, artherosclerosis , muscle weakness, eczema , dermatitis.

3-kidney damage ( actually high incident of viequenses   are in dialysis  treatment )  with associated urinary loss of essential minerals, amino acids and protein .

4-Heavy metal affects metabolism of zinc , cooper nucleic acid and progesterone.

Four: Questions,  Comments,  Petitions  and Justification 

Question

Is the   measuring  of the substances  and their byproducts in the Viequenses  blood is  specific for chronic  heavy metal intoxication?

Comments

1- Chronic heavy metal intoxication cannot be found in  regular heavy metal blood test, but is good for acute heavy metal  intoxications.

2-  The chronic low level exposure is consistent  with the viequenses  symptons and diseases .

3-In a  Blood Cell  Element Analysis  from Doctors' Data Laboratories  it can be determined the elevated or excessive levels of the five  potentially toxic elements accumulated in erythrocytes: Antimony , Arsenic, Cadmium, Mercury and Lead.

Petitions

1- We need  from the ATSDR at least  one hundred test  of  Red Cell Analysis.   Red Blood Cell  Element Analysis  from Doctors' Data Laboratories to those viequenses that  suffer from   specific health conditions  relative to heavy metal intoxication to determine elevated or excessive levels of five  potentially toxic elements that can accumulate in erythrocytes: antimony, arsenic, cadmium, lead, and mercury.

Justifications

1- This analysis of elements in packed blood cells  performed by ICP-Mass Spectroscopy following acid digestion of the specimen in a closed microwave system. For a given element these procedures measure the sum of the amounts of surface-adhering and intracellular content, regardless of chemical form  is excellent to obtain additional information of heavy metal intoxication.

2-Additional , is extremely  important for  the ATSDR Fresh Look  systematic and scientifically  rigorous  biomonitoring  program to find out substances  in  chronic heavy metal intoxication and  nutritional status for posterior   Viequenses  treatment for metal toxicity.

Note : Attachment , Packed Book Cell Elements Report   Doctor's Data laboratories

Final Comennt

We have taking time out of our busy schedule to help the community of Vieques  with no salary  with our own economical expenses , we have dedicated our time to the health of this community. In return all  we are expecting for is that the accountability of the ATSDR and their scientific  staff  correspond this time. We hope for the people, infants , children, and elderly in Vieques that this health issue will be looked into and  worked with and the Viequenses could have a chance at a healthier life

Dr. Carmen ColondeJorgeLicensed  Pharmacist Licensed Naturopath Doctor of Naturopathy (D.N.),

Carta al congresista Ruthman .

  Fué entregada  el 8 de diciembre de 2009 en la oficina del Comicionado Residente en Washington, él  Honorable Pedro R. Pierlusi puesta en manos de la distinquuida dama Rosemarie ( Maí ) Vizcarrondo  Directora de Distrito.

Carmen M. Colón de Jorge D. N. N.L. B.SPh. 

Licensed Pharmacist,  Licensed  Naturopath ,Puerto Rico

Doctor of Naturopathy  Reg.275 Washington D.C.

Ex-President Examination Board of Naturopath, P.R.

President  Scientific Committee of Licensed Naturopaths of Puerto Rico

Phone 787-633-9603,787-888-6904  email, naturopatiahoy@gmail.com

www.karmenhomeoterapy.com                            

Collaborates:

Scientific Committee  of Licensed Naturopaths Association of Puerto Rico

John Ferrer Brooks M.D. Licensed Naturopath

Francisco Lopez Perez , B.A. Licensed Naturopath

Health Professional  for  Vieques

                                                                                                                       December 8,2009   

Re: ATSDR Biomonitoring at Vieques

Mr.Congressman Rothmans:

Congress of The United  States of America

     I am writing to you on behalf of  Vieques people ,on  the group of puertorican Scientifics an on others collaborates . I want to present you a document to discuss  with the ATSDR,  that  we title:  Dr. Carmen Colón de Jorge: A Fresh Look to the ATSDR's Fresh Look at Environmental Chemical Exposures on the Island of Vieques. Areview to ATSDR Biomonitoring

    In 1997-1999 I opened for first time  in Puerto Rico  the discussion  of viequenses contamination with heavy metal. I  was alarmed  about   the finding  of high level of  Antimony , Cadmium, Mercury  and Uranium  in the  Hair Elements Analysis of  my patients  from Vieques . I did some press release and radio programs for alert the community. Then, I decided to go personally  house to house in Vieques  to  do hair analysis to   people with special health conditions.

I did  30 Hair Element Analysis  from Doctor's Data Laboratories,a respectable Medicare Provider and  additional   7 Fecal Element  Analysis , including an infant 18 month old and  Milivi Adams a  2 years old Toddler girl dying of cancer. 

My  finding was later confirmed with posterior  investigation of  Dr. Carmen Ortiz Roque from the College of Medicine Doctors. The Department of Health  from Puerto Rico in their Executive Summary of the Prevalence Study of Heavy Metal in Vieques November , 2006 also comfirm.

Our group of scientists , on the Scientific Consultation with Dr. Howard  Frumkin at the ATSDR (5 and 6 November 2009) we discussed   the strength,  limitation and recommendation for  further work as it applies to ours investigations .  Some  differences on the t ATSDR Biomonitoring is the reason to create a document to discuss in the further  work with the ATSDR. We title the document  Dr. Carmen Colon de Jorge  Fresh Look to the ATSDR's Fresh Look at Environmental Chemical Exposures on the Island of Vieques. We need your further  attention and help  vieques population in the accountability of the ATSDR that  you has  requested.

                          Thanks for your attention  to Vieques  people heavy metal contamination and for less cancer incident in the future specially in our babies.

Dr. Carmen M. Colón de Jorge

   7 Attachments included

November 13, 2009

Summary

ATSDR is currently engaged in a “fresh look” at environmental health concerns on the Island of Vieques, Puerto Rico.  This progress report describes the status of ATSDR’s review of its own work and other reports on environmental exposures and health effects on Vieques.  It describes the direction ATSDR will take as it reaches final conclusions.  This progress report is based on internal agency review, a site visit to Vieques in August 2009, and a scientific consultation with experts from Puerto Rico and other universities in November 2009.  A final report is expected in early 2010.  ATSDR expects to:

• change some of its earlier conclusions regarding the safety of environmental exposures on Vieques; 
• recommend biomonitoring to determine whether persons living on Vieques have been exposed to harmful chemicals, and, if so, at what levels those chemicals may be in their bodies;
• work with Puerto Rican health officials to conduct more in-depth evaluation of health outcomes;
• work with community members and Puerto Rican health officials to issue science-based, precautionary recommendations to protect public health;
• work with partners in the Puerto Rican health care community to encourage improved access to health care for residents of Vieques; and
• coordinate an inclusive, accountable process featuring participation of Puerto Rican community members and professionals in moving forward.

Background

In 1999, a resident of the Island of Vieques petitioned the Agency for Toxic Substances and Disease Registry (ATSDR) to evaluate environmental data for the island and to determine if health risks had resulted from bombing conducted on the island by the United States Navy.  Between 2001 and 2003, ATSDR released four public health assessments (PHAs).  Each PHA assessed a specific pathway for possible exposure to chemicals – seafood (fish, shellfish and land crabs), drinking water, air and soil.  In conducting its evaluation, ATSDR used the public health assessment methodologies described in its Public Health Assessment Guidance Manual, which can be found at http://www.atsdr.cdc.gov/HAC/PHAManual/index.html.  Each PHA was peer-reviewed before its final release.  The PHAs concluded, based on data and modeling, that no health hazard was associated with any pathways evaluated, except drinking water from one local well and eating lobsters.

Scientists and members of the Vieques community expressed dissatisfaction with ATSDR’s findings, believing that military maneuvers left residual environmental hazards that must have impacted the health of Viequenses.  In March 2009, Congressman Stephen Rothman (D-NJ) requested that ATSDR revisit our evaluation of Vieques. Acknowledging the community’s concerns, ATSDR made a commitment to take a fresh look at Vieques. As we take this fresh look, ATSDR believes it is imperative that we review all available environmental, human biomonitoring and health outcome studies that have been conducted for Vieques. ATSDR has gathered more than 75 documents reporting on environmental sampling, health outcomes, and biomonitoring.

In August 2009, ATSDR director Dr. Howard Frumkin, accompanied by scientists and staff, visited Vieques and met with community leaders and Puerto Rican scientists and health officials.  An outcome of those meetings was a commitment to involve local experts in ATSDR’s review of Vieques.  ATSDR requested that Puerto Rican scientists and others who have studied Vieques participate in a scientific consultation.  That meeting was held in Atlanta, Georgia on November 5-6, 2009 and entailed a thorough review of multiple studies.  Participants in the scientific consultation identified the strengths and limitations of many of the studies and made recommendations for further work.

ATSDR greatly appreciates the scientists taking time to travel to Atlanta and share their findings and perspectives.  We salute the independent scientists and community leaders for their dedication to the health of the people of Vieques, and we look forward to working with them as we move forward with our fresh look at Vieques.  

Based on its review and the expert consultation, ATSDR has identified directions it will follow in reaching conclusions and issuing recommendations.  This progress report describes those directions.  They fall into six categories:

• Findings regarding environmental contamination
• Findings regarding biomonitoring
• Findings regarding health outcomes
• Recommendations for public health protection
• Recommendations regarding health care access
• Plans for conduct of future work.

Environmental Contamination

Much work, by ATSDR and others, has focused on assessing levels of environmental contaminants on Vieques.  ATSDR identified gaps in some of the data on which its previous reports relied, such as limits in air monitoring and soil data.  ATSDR also identified conclusions in its previous reports that did not adequately consider vulnerable populations or express the limitations and uncertainty of the findings.  Finally, ATSDR identified data produced by Puerto Rican and other investigators, such as analyses of some plants, which provided a more complete picture of environmental contamination on the island and in offshore marine ecosystems.  As a result, ATSDR will modify some of its earlier conclusions.  In some cases this will involve recalculating exposures with a focus on high-risk populations (e.g., heavy fish eaters, pregnant women, children) and worst-case scenarios.  In addition, ATSDR will address the U.S. Food and Drug Administration’s fish consumption recommendations for pregnant women as they relate to the fish consumed on Vieques.  ATSDR also will provide more information on the uncertainty of the data used to estimate people’s exposures. ATSDR also will discuss additional pathways, such as the marine environment and locally-grown produce.    

ATSDR will redouble efforts to obtain all available information from other agencies on what contaminants may have been released on Vieques during past bombing.  ATSDR will recommend studies to fill gaps in available environmental data, such as surveys to determine food consumption patterns as well as sampling to determine contaminant levels in the edible portions of locally grown produce.  ATSDR will work with our partners to identify ways of completing these recommendations.

Biomonitoring

Biomonitoring is the direct measurement of people's exposure to toxic substances in the environment, conducted by measuring the substances or their byproducts in blood, urine and sometimes hair.  Biomonitoring measurements are highly health-relevant because they indicate the amount of the chemical that actually gets into people from all environmental sources (e.g. air, water, soil, food, dust).  Several biomonitoring studies have suggested that humans have been exposed to environmental chemicals on the island of Vieques. The chemical exposures of greatest concern appear to include aluminum, arsenic, mercury, uranium, cadmium, and, possibly, by-products of explosives. ATSDR is also investigating other chemicals that may deserve attention as well, even though available data may be limited.  ATSDR plans to work with our partners to implement a systematic and scientifically rigorous biomonitoring program. 

Health Outcomes

Puerto Rican health professionals reported the impression that the Vieques population suffers significant elevations of illness and mortality.  Specific health concerns include cardiovascular disease, kidney disease, and cancer.  Several sources of health data exist including cancer incidence and mortality data.  ATSDR believes that these data warrant further investigation, and will consult with Puerto Rican health professionals and public health agencies in advancing this goal.

Public Health Protection

ATSDR is committed to issuing science-based recommendations that will help protect the health of the people of Vieques.  Appropriate recommendations may include advisories regarding fish consumption and consumption of locally grown produce, and ATSDR will consider such recommendations.  In addition, ATSDR recognizes community concern about open burning of vegetation and ongoing detonation of unexploded ordnance.  Some community members have the misimpression that ATSDR has approved or issued permits for open burning and detonation.  ATSDR has no authority over this permitting process; this authority rests with the Puerto Rico Environmental Quality Board.  ATSDR is aware of the complex tradeoffs required in deciding how best to remediate the Live Impact Area.  We urge a thorough review of the proposed procedures, with consideration of the entire range of options for removal of ordnance, involvement of the community in every aspect of these discussions, and selection of the most health-protective course of action.

Health Care Access

ATSDR is aware of limitations of health care access on Vieques, such as access to cancer treatment.  Although ATSDR cannot provide this care, we will work with our public health and health care partners in the community to seek improvement in access to health care.

Plans for Conduct of Future Work

ATSDR scientists will prepare a summary report addressing the topics noted above, including a critical evaluation of previous environmental health work done for Vieques and recommendations.  As part of the scientific process, this report will be peer reviewed by independent experts.  An opportunity for public comment on the report will be offered before it is finalized.

As part of its fresh look, ATSDR recognizes and endorses the need for oversight and accountability, including strong local involvement in our activities on Vieques.  Both in preparing the final report, and in moving ahead with future work, ATSDR commits to an inclusive, accountable process.

 Naval bombing of Vieques

 LOS  BONBARDEOS DE LA MARINA  EN VIEQUES 

HA GENERADO DESDE 1999 LA SOSPECHA DE  QUE LA PROLIFERACION DE MULTIPLES ENFERMEDADES   EN LA ISLA DE 9,OOO HABITANTES  TIENE UNA RELACION DIRECTA CON LA PRACTICA DE BONBARDEO DE LA MARINA DE LOS ESTADOS UNIDOS POR MAS DE 6 DECADAS  LA ISLA

 Estudios realizados por la Dra.Carmen M. Colón de Jorge EN  1999 

 1-29 estudios multielementos de cabellos de infantes, niños y adultos  

2-7 heces  fecales se realizaro

condiciones de cancer, asma,  lupus, fibromialgia, tumores, Asma, condiciones  psicológicas como depresión  , alergias y otras

3-7 análisis comparales  fuera de Vieques

COMUNICADO DE PRENSA  DEL ATSDR

NEW YORK TIMES

13 noviembre del 2009

RESUMEN DEL ATSDR

ATSDR's Fresh Look at Environmental Chemical Exposures on the Island of Vieques - Progress Report

November 13, 2009

Summary

ATSDR is currently engaged in a “fresh look” at environmental health concerns on the Island of Vieques, Puerto Rico.  This progress report describes the status of ATSDR’s review of its own work and other reports on environmental exposures and health effects on Vieques.  It describes the direction ATSDR will take as it reaches final conclusions.  This progress report is based on internal agency review, a site visit to Vieques in August 2009, and a scientific consultation with experts from Puerto Rico and other universities in November 2009.  A final report is expected in early 2010.  ATSDR expects to:

• change some of its earlier conclusions regarding the safety of environmental exposures on Vieques; 
• recommend biomonitoring to determine whether persons living on Vieques have been exposed to harmful chemicals, and, if so, at what levels those chemicals may be in their bodies;
• work with Puerto Rican health officials to conduct more in-depth evaluation of health outcomes;
• work with community members and Puerto Rican health officials to issue science-based, precautionary recommendations to protect public health;
• work with partners in the Puerto Rican health care community to encourage improved access to health care for residents of Vieques; and
• coordinate an inclusive, accountable process featuring participation of Puerto Rican community members and professionals in moving forward.

Background

In 1999, a resident of the Island of Vieques petitioned the Agency for Toxic Substances and Disease Registry (ATSDR) to evaluate environmental data for the island and to determine if health risks had resulted from bombing conducted on the island by the United States Navy.  Between 2001 and 2003, ATSDR released four public health assessments (PHAs).  Each PHA assessed a specific pathway for possible exposure to chemicals – seafood (fish, shellfish and land crabs), drinking water, air and soil.  In conducting its evaluation, ATSDR used the public health assessment methodologies described in its Public Health Assessment Guidance Manual, which can be found at http://www.atsdr.cdc.gov/HAC/PHAManual/index.html.  Each PHA was peer-reviewed before its final release.  The PHAs concluded, based on data and modeling, that no health hazard was associated with any pathways evaluated, except drinking water from one local well and eating lobsters.

Scientists and members of the Vieques community expressed dissatisfaction with ATSDR’s findings, believing that military maneuvers left residual environmental hazards that must have impacted the health of Viequenses.  In March 2009, Congressman Stephen Rothman (D-NJ) requested that ATSDR revisit our evaluation of Vieques. Acknowledging the community’s concerns, ATSDR made a commitment to take a fresh look at Vieques. As we take this fresh look, ATSDR believes it is imperative that we review all available environmental, human biomonitoring and health outcome studies that have been conducted for Vieques. ATSDR has gathered more than 75 documents reporting on environmental sampling, health outcomes, and biomonitoring.

In August 2009, ATSDR director Dr. Howard Frumkin, accompanied by scientists and staff, visited Vieques and met with community leaders and Puerto Rican scientists and health officials.  An outcome of those meetings was a commitment to involve local experts in ATSDR’s review of Vieques.  ATSDR requested that Puerto Rican scientists and others who have studied Vieques participate in a scientific consultation.  That meeting was held in Atlanta, Georgia on November 5-6, 2009 and entailed a thorough review of multiple studies.  Participants in the scientific consultation identified the strengths and limitations of many of the studies and made recommendations for further work.

ATSDR greatly appreciates the scientists taking time to travel to Atlanta and share their findings and perspectives.  We salute the independent scientists and community leaders for their dedication to the health of the people of Vieques, and we look forward to working with them as we move forward with our fresh look at Vieques.  

Based on its review and the expert consultation, ATSDR has identified directions it will follow in reaching conclusions and issuing recommendations.  This progress report describes those directions.  They fall into six categories:

• Findings regarding environmental contamination
• Findings regarding biomonitoring
• Findings regarding health outcomes
• Recommendations for public health protection
• Recommendations regarding health care access
• Plans for conduct of future work.

Environmental Contamination

Much work, by ATSDR and others, has focused on assessing levels of environmental contaminants on Vieques.  ATSDR identified gaps in some of the data on which its previous reports relied, such as limits in air monitoring and soil data.  ATSDR also identified conclusions in its previous reports that did not adequately consider vulnerable populations or express the limitations and uncertainty of the findings.  Finally, ATSDR identified data produced by Puerto Rican and other investigators, such as analyses of some plants, which provided a more complete picture of environmental contamination on the island and in offshore marine ecosystems.  As a result, ATSDR will modify some of its earlier conclusions.  In some cases this will involve recalculating exposures with a focus on high-risk populations (e.g., heavy fish eaters, pregnant women, children) and worst-case scenarios.  In addition, ATSDR will address the U.S. Food and Drug Administration’s fish consumption recommendations for pregnant women as they relate to the fish consumed on Vieques.  ATSDR also will provide more information on the uncertainty of the data used to estimate people’s exposures. ATSDR also will discuss additional pathways, such as the marine environment and locally-grown produce.    

ATSDR will redouble efforts to obtain all available information from other agencies on what contaminants may have been released on Vieques during past bombing.  ATSDR will recommend studies to fill gaps in available environmental data, such as surveys to determine food consumption patterns as well as sampling to determine contaminant levels in the edible portions of locally grown produce.  ATSDR will work with our partners to identify ways of completing these recommendations.

Biomonitoring

Biomonitoring is the direct measurement of people's exposure to toxic substances in the environment, conducted by measuring the substances or their byproducts in blood, urine and sometimes hair.  Biomonitoring measurements are highly health-relevant because they indicate the amount of the chemical that actually gets into people from all environmental sources (e.g. air, water, soil, food, dust).  Several biomonitoring studies have suggested that humans have been exposed to environmental chemicals on the island of Vieques. The chemical exposures of greatest concern appear to include aluminum, arsenic, mercury, uranium, cadmium, and, possibly, by-products of explosives. ATSDR is also investigating other chemicals that may deserve attention as well, even though available data may be limited.  ATSDR plans to work with our partners to implement a systematic and scientifically rigorous biomonitoring program. 

Health Outcomes

Puerto Rican health professionals reported the impression that the Vieques population suffers significant elevations of illness and mortality.  Specific health concerns include cardiovascular disease, kidney disease, and cancer.  Several sources of health data exist including cancer incidence and mortality data.  ATSDR believes that these data warrant further investigation, and will consult with Puerto Rican health professionals and public health agencies in advancing this goal.

Public Health Protection

ATSDR is committed to issuing science-based recommendations that will help protect the health of the people of Vieques.  Appropriate recommendations may include advisories regarding fish consumption and consumption of locally grown produce, and ATSDR will consider such recommendations.  In addition, ATSDR recognizes community concern about open burning of vegetation and ongoing detonation of unexploded ordnance.  Some community members have the misimpression that ATSDR has approved or issued permits for open burning and detonation.  ATSDR has no authority over this permitting process; this authority rests with the Puerto Rico Environmental Quality Board.  ATSDR is aware of the complex tradeoffs required in deciding how best to remediate the Live Impact Area.  We urge a thorough review of the proposed procedures, with consideration of the entire range of options for removal of ordnance, involvement of the community in every aspect of these discussions, and selection of the most health-protective course of action.

Health Care Access

ATSDR is aware of limitations of health care access on Vieques, such as access to cancer treatment.  Although ATSDR cannot provide this care, we will work with our public health and health care partners in the community to seek improvement in access to health care.

Plans for Conduct of Future Work

ATSDR scientists will prepare a summary report addressing the topics noted above, including a critical evaluation of previous environmental health work done for Vieques and recommendations.  As part of the scientific process, this report will be peer reviewed by independent experts.  An opportunity for public comment on the report will be offered before it is finalized.

As part of its fresh look, ATSDR recognizes and endorses the need for oversight and accountability, including strong local involvement in our activities on Vieques.  Both in preparing the final report, and in moving ahead with future work, ATSDR commits to an inclusive, accountable process.