Ever wonder if asthma is linked to
air pollution? Google "Air Pollution and Asthma" and one of the
references that will come up on the first page is an op-ed by Dr. Joseph
Perrone. I would expect a person with a PhD to be objective, unbiased, and
scientific. My expectations were not met. Read on to see if you agree.
A. Background
According to the federal Clean Air Act
the Environmental Protection Agency (EPA) is required to review ground ozone
standards every five years. Ground level
ozone is the product of nitrogen oxides chemically reacting with volatile
organic compounds in the air. These chemicals come from industrial processes,
coal-powered electric power plants, chemical solvents, and the oxidation of
gasoline. The standard for ozone adopted in 2008 was 75 parts per billion
(ppb).
In 2015 the standard was lowered to 70 ppb. States and metropolitan areas have
until 2025 to reach compliance with the 70 ppb ozone level. According to
Congressional Research Service, as of 2017, approximately 40% of the U.S.
population lived in areas that did not comply with the national ozone
standards.
While Perrone's op-ed was published eight months before the 70 ppb standard was
decided, his purpose seems to be to question the legitimacy of every EPA air
pollution regulation.
B.
No link between asthma and air pollution? Really?
The
following excerpt is from Perrone's op-ed in The Hill.
Upending
EPA’s science on pollution and asthma
By
Joseph Perrone, Ph.D. — 01/31/15 01:00 PM EST 11
For
years, environmentalists and regulators have cited childhood asthma as an
excuse for ever-stricter pollution rules. The U.S. Environmental Protection
Agency (EPA), for instance, uses asthma as a pretext for nearly every “clean
air” regulation issued since the 1970s.
But
what if the assumed link between air pollution and childhood asthma doesn’t
actually exist?
New
research questions the long-held wisdom on asthma and air pollution, casting
doubt over the scientific basis for EPA’s expansive regulatory agenda.
The
new peer-reviewed paper, authored by a team of prominent researchers led by Dr.
Corrine Keet of John’s Hopkins Children’s Center, studied over 23,000 U.S.
children and found no statistically significant difference in asthma rates
between those who live in inner-city neighborhoods (and are thus subject to
higher pollution levels) and those who do not (once controlling for other
factors). Instead, researchers concluded that poverty was a greater predictor
for higher asthma rates than outdoor air pollution.
My
take: The Keet study found no significant difference in asthma rates between
those who live in the inner city, are presumably poorer, and have greater
exposure to indoor air pollutants and those who do not live in inner-city
neighborhoods and are not exposed to indoor air pollutants associated with
poverty. But Dr. Perrone claims that
"researchers concluded that poverty was a greater predictor for higher
asthma rates than outdoor air pollution.” But how could that be since this
study finds no significant difference in asthma rates between the two groups?
According to this study, air pollution (outdoor or indoor) does not affect the
rates of childhood asthma. Based on that, is it logical to conclude that
outdoor air pollution, indoor air pollution and/or poverty has no effect on the
rates of adult respiratory problems including asthma, nor on the rates of
childhood respiratory problems other than asthma?
C.
Evidence
of a Link
Dr.
Perrone appears to be questioning the wisdom, relevance, or necessity of every
clean air regulation issued by the EPA since the 1970s by suggesting that there is no scientifically verified link between outdoor air
pollution and childhood asthma. What follows is an excerpt from an article
about another research study by Dr. Corrine Keet which suggests that there is,
in fact, a link.
Inner-city residence linked to pediatric
asthma morbidity, not prevalence
March 29, 2017
Among children enrolled in Medicaid
between 2009 and 2010 (16,860,716), 1,534,820 were considered asthmatic. For
these children, inner-city residence did not correlate with an increased risk
in asthma prevalence in crude or adjusted analyses. However, residency in inner
cities did demonstrate more asthma-related ED visits and hospitalizations
when using crude analyses and when adjusted for age, race/ethnicity and gender.
“It is very likely that no one
exposure accounts for the increased asthma morbidity associated with living in
poor or urban areas. Researchers studying asthma in the inner city have
established that exposure to common household pests that are
more common in poor and urban areas, such as cockroaches and mice, is
associated with worse asthma control,” Keet and colleagues wrote. “Air
pollution, which may act synergistically with allergen exposures, is another
likely contributor to increased morbidity in poor and urban areas. [Urban areas
tend to be] closer to stationary sources of air pollution … and thus have
higher levels of pollutants associated with asthma morbidity, such as
particulate matter, nitric oxides and ozone.” — by Katherine Bortz
My
comment: Neither of Keet's studies establishes a cause-effect relationship
between air pollution and asthma. According to this study, outdoor air
pollution, which is greater in the inner city than elsewhere, may contribute to
increased morbidity (the degree to which the health condition affects the
patient) of asthma
related symptoms in inner-city residents 5-19 years of age.
It
has been suggested to me that the quality of health care of inner city children
may be inferior to that of children not living in the inner city and that
that may be why the morbidity is greater among children living in
poverty. There is also reason to believe that education of children
in regard to managing their asthma symptoms decreases morbidity. Such education
may be imparted more frequently or more effectively to non-impoverished white
children than to poor minority children.
The implication of suggesting that
there are other possible factors that affect morbidity of childhood asthma
other than pollution is that regulating air quality will not have a positive
effect on asthma morbidity. Even if that were true, does it follow
that outdoor air
pollutants have no negative effect on anyone's health? One needs only to
consider the deaths caused by thermal inversion events in which outdoor air
pollutants are concentrated at ground level to understand that pollutants can
have negative effects on human health. If that is not enough evidence, consider
people who have to breathe pure oxygen from time to time. It would be difficult
to argue that they would not be better off if there were no ozone and fine
particulate pollution. Even if children with asthma are not helped by decreased
levels of air pollutants, other people certainly are helped; people possessing
the inalienable right to live healthfully.
These articles also
neglect to mention the negative effect that outdoor pollution can have on
indoor air quality. “Many
studies indicate that indoor air quality is affected by outdoor air" (Baek et
al., 1997;
Jones et
al., 2000;
Kuo and
Shen, 2010;
Meadow et
al., 2014;
Fung et
al., 2014). (https://www.frontiersin.org/articles/10.3389/fenvs.2014.00069/full#h6).
D. A "Scientific" Ozone
Study
Another excerpt from Dr. Perrone's
op-ed follows.
Upending EPA’s science on pollution
and asthma
By Joseph Perrone, Ph.D. — 01/31/15
01:00 PM EST
... EPA is preparing to
tighten national standards for ground-level ozone (the main
ingredient in smog) by as much as 20 percent…
But it’s hard to see how
lowering the current ozone limit either “follows the science” or “protects
those most at-risk” for asthma.
A peer reviewed study by Dr. William Adams, for instance,
found no statistically significant difference in lung function in humans
exposed to ozone at 80 ppb (5 ppb above the current standard) or 60 ppb (the
low end of the EPA’s proposed new standard).
My
take: If an author wishes to discredit the desirability of EPA's tightening of
ozone standards, would it be wise to choose a scientific study that subjected
30 young people (15 men, 15 women) without respiratory problems to temporarily breathing
air with .06 ppm and .08 ppm of ozone respectively, followed by assessment of lung
function at each level? If one reads the Adams study (https://www.tandfonline.com/doi/abs/10.1080/08958370500306107?journalCode=iiht20), one finds out that
that is what the study involved. If it demonstrates anything, this study only
tells us that the respiratory health of the thirty test subjects would not
suffer from breathing .08 ppm or less of ozone for short periods of time. The
number of subjects is not large enough to scientifically conclude that this
would be true of the general population. Nor is this study applicable to other
age groups nor to young adults with asthma or with other respiratory problems.
If an author wanted to prove that the EPA has no scientific basis for
decreasing ozone limits, one might wonder why he/she would not find a better
study to cite than this one. One reason could be that there are no better studies.
E.
Do regulations really make asthma worse?
In the following excerpt, Perrone addresses the financial aspect of pollution
regulations and asthma.
Upending EPA’s science on pollution and
asthma
By
Joseph Perrone, Ph.D. — 01/31/15 01:00 PM EST
In
fact, EPA’s ozone reductions may actually make asthma worse.
As
Dr. Keet’s research points out, one of the greatest risk factors of childhood
asthma is poverty—not outdoor air pollution. At a cost of $90 billion per year,
by EPA’s own admission, the ozone rule would place millions of jobs in jeopardy
and exacerbate poverty, which could actually increase asthma rates.
My response: The EPA's own
"admission" of the ozone rule costing $90 billion annually is
misleading. As noted at the beginning of this blog, the EPA, by law, must
assess the current ozone level every five years. This may involve the
possibility of lowering the level. Consideration of lower standards involves
assessing the costs as well as the financial benefits of doing so. “EPA's cost estimates for a 60 ppb standard had a high of $90
billion…” (https://www.uschamber.com/issue-brief/ozone-national-ambient-air-quality-standards) Note: The $90 billion dollars refers to 60 ppb, not 70
ppb, the current standard.
Perrone also fails to mention the
EPA’s estimation of cost savings and health benefits resulting from the 70 ppb
ozone levels. Those would be $2.9 - $5.9 billion annually. The EPA predicts
that, by 2025, the reduction of ozone and particle pollution will prevent
hundreds of thousands of childhood asthma attacks and hundreds of ER
asthma-related visits. The EPA estimates the annual cost of the 70 ppb standard
is $1.4 billion, nowhere near the $90 billion cited by Perrone. “Since 1970, we have cut harmful air pollution by about 70%
while the US economy has more
than tripled.” (//https://www.epa.gov/sites/production/files/2015-10/documents/20151001_bynumbers.pdf).
According to World Bank statistics,
in 1960 the GDP (Gross National Product) of the US was $543.3 billion. In 2016
it was $18.6244 trillion (https://data.worldbank.org/indicator/NY.GDP.MKTP.CD). As I point out in my book Inalienable Rights
versus Abuse: a Commonsense Approach to Public Policy, if the EPA is
abolished, thousands of government employees will be unemployed as well as
employees of private companies that have been formed to help other companies
comply with EPA regulations. Since its formation in 1970, the EPA has helped
the GDP to grow.
What the economic expansion has not
done is to decrease poverty in the United States. In 1970 there were about 25
million Americans living in poverty. There were about 45 million poor Americans
in 2013 (https://www.census.gov/content/dam/Census/library/publications/2016/demo/p60-256.pdf). Rather than trying to blame that increase in poverty
on EPA regulations, we should consider the increasing degree of disparity
between poor and middle class Americans and the ultra-rich. According to Mother
Jones, “The average income for the top 0.01 percent of households grew an
astounding 322 percent, to $6.7 million, between 1980 and 2015. Despite seeing
3.9 percent growth in the last year, the highest rate since 1998, the average
income of the bottom 90 percent has effectively flatlined, increasing just 0.03
percent since 1980.” (https://www.motherjones.com/politics/2016/12/america-income-inequality-wealth-net-worth-charts/). Endangering public health by rescinding regulations that are protecting environmental quality will result in increased economic disparity by making the rich richer and the poor sicker.
F. Why is Perrone's op-ed so
obviously slanted and inaccurate?
I
kept asking myself that question as I was researching. I finally
read, at the end of the op-ed, the following disclosure:
Perrone is the chief science officer at
the Center for Accountability in Science, a project of the nonprofit Center for
Organizational Research and Education. CORE is supported by a wide variety of
businesses and foundations, including those in the hospitality, agriculture,
and energy industries.
If this op-ed was an attempt to justify Trump's EPA rescinding environmental regulations, it is a dismal failure. I am open to hearing any rational argument suggesting that I am mistaken.
