This report is part of a joint project by InsideClimate News and the Center for Public Integrity.
Like people in other regions transformed by the shale energy boom, residents of Washington County, Pennsylvania have complained of headaches, nosebleeds and skin rashes. But because there are no comprehensive studies about the health impacts of natural gas drilling, it's hard to determine if their problems are linked to the gas wells and other production facilities that have sprung up around them.
A group of scientists from Pennsylvania and neighboring states have stepped in to fill this gap by forming a nonprofit—apparently the first of its kind in the United States—that provides free health consultations to local families near drilling sites. Instead of waiting years or even decades for long-term studies to emerge, the Southwest Pennsylvania Environmental Health Project (SWPA-EHP) is using the best available science to help people deal with their ailments.
"As far as unconventional natural gas drilling goes, we are the public health service of the United States right now," said Michael Kelly, the media liaison for the EHP.
David Brown, a toxicologist and the group's co-founder, said government agencies haven't done enough to study, analyze and mitigate the risks people face from drilling.
The Pennsylvania Department of Environmental Protection—which oversees the oil and gas industry—has no ongoing or planned health studies, though it is researching air and water quality at certain sites, Scott Perry, the agency's director of oil and gas management, said at a media event last month. None of the hundreds of millions of dollars in impact fees the state has collected from the industry since 2011 has gone to state or local health departments.
InsideClimate News contacted the Pennsylvania Department of Health multiple times over a two-week period to ask how it manages the public health risks of unconventional gas drilling. The agency did not provide any answers, even though two spokespeople—Yasmin Coleman and Tom Hostetter—said the department would respond to the questions. A governor-appointed commission recommended in 2011 that a health registry be created to track Pennsylvanians living near drilling sites. But no registry has been established. In June, the news organization StateImpact Pennsylvania reported that two former employees of the health department were told to avoid talking about Marcellus shale activity, and to stop returning phone calls from people concerned about drilling impacts.
The EPH's decision to take a public health approach, rather than focus on research, was an ethical one, said Brown, a former chief of environmental, epidemiology and occupational health at the Connecticut Department of Public Health.
"We saw that people were sick, and the risks [from shale extraction] were plausible," he said. "You really cannot or should not do studies on sick people...without providing some sort of assistance. You should help them get better."
EHP does not advocate for or against shale development. Too often, said Brown, residents who are sick end up "neglecting themselves" by spending all their energy trying to stop drilling in their backyards instead of seeking medical help.
Based in McMurray, a small community about 15 miles southwest of Pittsburgh, EHP's services are available to anyone who makes an appointment at the clinic, where the staff of five will:
explain what scientists know and don't know about the risks and impacts of shale gas development.
provide tips on how to reduce exposure to natural gas activities, perhaps by using indoor air filters or keeping daily logs of symptoms, odors and wind direction.
lend simple air monitors so residents can track the air quality inside their homes to determine when and how often they are exposed to certain air pollutants.
"In a sense, they're filling a role that some of the public health agencies have not been fulfilling," said Lisa McKenzie, a researcher at the Colorado School of Public Health who studies gas drilling impacts.
When people blame their health problems on gas drilling, the EHP staff sifts through the clues to find the most probable explanation by taking into account a patient's medical history, their proximity to shale activity and other industrial sites. In addition to the clinic staff, seven other EHP scientists based across New England provide support.
EHP's nurse practitioner, Suann Davison, meets one-on-one with patients and also conducts house calls in and around Washington County. When health problems are likely linked to drilling, patients may be referred to pulmonologists or other specialists.
If someone lives 20 miles from the nearest well, their symptoms probably aren't related to shale gas, said EHP director Raina Rippel. The link would be much stronger for a resident downwind of a gas well who develops new respiratory problems or worsening pre-existing symptoms after the drilling starts.
"If we can document there was a probable exposure and absence of a more likely explanation, like an underlying medical problem, then I think it helps us define it as more than just self-reported health impacts," said Rippel, a former community organizer who led the advocacy group Center for Coalfield Justice.
Davison said her patients usually have a combination of symptoms including respiratory problems, rashes and lesions, irritated eyes, nosebleeds, numbness, tingling, headaches, nausea and vomiting. These symptoms have been linked to some of the chemicals emitted during shale development, including formaldehyde, particulate matter and volatile organic compounds. Other compounds may be linked to water pollution.
She said the work makes her feel like "one of the first explorers," searching for some certainty in a field where so much basic research remains to be done. Before joining EHP last year, she worked for 10 years in the U.S. Air Force, first as a registered nurse, then as a family nurse practitioner.
Davison was attracted to EHP in part because of its neutral stance on gas drilling. "We're not saying frack or don't frack...I wanted to care for members in this community," she said. "I'm not an environmentalist."
Some of her patients are wary of the industry, but others are landowners who leased their mineral rights and now worry about the health impacts. "It doesn't matter to us [who they are]," she said. "We'll see anyone."
'A Houston, Texas Kind of Scene'
EHP was launched in 2011 with a grant from the Heinz Endowments, a Pittsburgh-based philanthropic organization that funds educational, cultural and community efforts, with a particular focus in Southwest Pennsylvania. The group also receives support from the Pittsburgh and Claneil Foundations.
Philip Johnson, senior program officer of the Heinz Endowments' environment program, began paying attention to the potential health risks of fracking in 2009, when he noticed a sharp increase in complaints from Western Pennsylvania residents.
"We realized we had a potential public health threat. Typically what happens when new threats emerge is you need information and data flows to separate anecdotes from empirical evidence...And there were really no intervention models like this we were aware of in the country," he said.
Heinz Endowments approached some public health experts for help. As part of the planning for what eventually became EHP, they interviewed residents, studied the available scientific research and toured communities near drilling sites.
Rippel, the EHP director, remembers being shocked at the size of a processing plant they visited in Houston, Pennsylvania. She said it took up about as much space as a football field and looked like a refinery. "It [was] almost reminiscent of a Houston, Texas kind of scene," she said.
'No One's Testing What's Going On'
Amelia Pare, a plastic surgeon in Washington County, said what EHP is trying to do is "laudable" and "the most positive thing we have. But it's nowhere near enough...It's a drop in the bucket for what's really needed."
Pare has lived in Southwest Pennsylvania for 15 years. Four or five years ago, she noticed patients coming in with strange symptoms, including lesions on their face. Most were poor and lived in areas with gas drilling.
Pare began searching for guidelines and practical tips that could help her patients.
If someone comes in with a skin problem that could be linked to drilling, what medical tests should she run? What experts should she turn to, and which specialists would be willing to see her patients, many who are on Medicaid? But she found few satisfactory answers, despite contacting everyone she could think of—poison control, her state legislators, national representatives, the Pennsylvania medical society, the Pennsylvania health department, the U.S. Environmental Protection Agency and the Centers for Disease Control and Prevention.
"There's no one doing research on this. No one's testing what's going on," she said. "I'm not against oil and gas drilling. I'm a Republican...I just think you need to do it safely, and you need to know what you're doing, and I don't think either of those things is happening right now."
Pare said EHP would have more of an impact if it went door to door collecting urine samples and tested them for exposure to fracking-related compounds. "The Heinz [Endowments] puts a lot of money into this, but not a lot has changed...The people that run [EHP] need to be more courageous. You've got to go out and test people."
Kelly, the EHP media liaison, said that kind of research is beyond the scope of EHP, which has an annual budget of about $750,000. Instead, the peer-reviewed research the group publishes is usually an outgrowth of its public health service.
In March, four EHP scientists published a paper explaining that the air monitors used by most state regulators rarely detect toxic emission spikes in shale fields. Some of the data for that study came from simple air monitors EHP developed with scientists at Carnegie Mellon University. Local residents used the monitors to track concentrations of particulate matter—a respiratory irritant—inside their homes. The results showed dramatic but fleeting spikes throughout the day.
EHP has also analyzed data from 27 patients whose symptoms were likely caused by shale drilling activity. Rippel said the patients were screened to eliminate other probable causes, and that the results could help other health professionals working with patients in drilling regions. EHP presented the cases at a science conference last summer and is preparing the data for peer-reviewed publication.
A blog post by Energy in Depth—an outreach arm of the Independent Petroleum Association of America—challenged the usefulness of drawing conclusions from just 27 patients. But Barry Johnson, a former assistant administrator at the Agency for Toxic Substances and Disease Registry (part of the CDC), said the type of case series EHP produced is "very common and useful in the practice of public health," because it can serve as a precursor to larger epidemiological studies.
As an example, he pointed to the evolution of the science that documented the appearance of AIDS.
It began with a few reports of people who were seriously ill and dying from a new collection of symptoms, said Johnson, now an adjunct professor of public health at Emory University. "These in effect became case studies, and you started putting together these kinds of cases, and asking questions [like] 'how widespread it this problem? Where is the origin?'
"I don't know what, if anything, can be caused by fracking," he said. "But I think we should find out."