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.
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 an op-ed in The Hill.
The following excerpt is from an op-ed in The Hill.
Upending
EPA’s science on pollution and asthma
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 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
(https://www.healio.com/pediatrics/allergy-asthma-immunology/news/online/%7Bf4dd3d7e-7155-4242-a515-643a393a84d0%7D/inner-city-residence-linked-to-pediatric-asthma-morbidity-not-prevalence)Keet CA, et al. J Allergy Clin Immunol. 2017; doi:10.1016/j.jaci.2017.01.036.
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.
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
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).
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.
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
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).
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/).
F. Why is Perrone's op-ed so obviously slanted and inaccurate?
Rick Geiger
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/).
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.
I think that, unfortunately, answers
the question.
Rick Geiger
