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The Big Reveal

In May 2019, David Templeton and Don Hopey published a bombshell report in the Pittsburgh Post-Gazette showing a spike in the diagnosis of rare childhood cancers in communities in southwestern Pennsylvania surrounded by shale gas operations (fracking). “The Human Toll: Risk and exposure in the gas lands” counted 27 cases of Ewing sarcoma — a rare, brutal, and frequently fatal pediatric bone cancer — and 40 cases of other rare cancers, for a total of 67 cases of rare cancers diagnosed in children, teenagers, and young adults between 2008-2018 in four heavily fracked counties in southwestern Pennsylvania. (Washington, Greene, Fayette, and Westmoreland).

Two months prior to that publication, the two reporters wrote an article focusing on the striking number of cancer diagnoses clustered in one Washington County school district (“CDC, state officials investigating multiple cases of rare cancer in southwest Pa,”), including six cases of Ewing sarcoma and 10 other rare cancers:


Those nine consist of two cases of osteosarcoma (bone); one liposarcoma (joint); one rhabdomyosarcoma (muscle); a Wilms (kidney) tumor in a child whose family has moved from the district; one liver cancer; two cases of leukemia (blood); and a 2-year-old with cancer that the parent declined to identify.

In another case, a 21-year-old Canon-McMillan graduate of North Strabane was diagnosed in early January with leukemia.


Even before Templeton and Hopey brought this disturbing news into public view, there was already abundant evidence showing that fracking was threatening the health and safety of Pennsylvanians living near fracking infrastructure — not just in people living near well pads where multiple wells are drilled and fracked, but also near roads teeming with diesel truck traffic, near compressor stations pushing gas through the vast network of underground pipelines, near gas processing facilities that collect and then separate and refine the fossil fuel, near landfills accepting toxic and radioactive fracking waste — where dangerous emissions and chemicals (methane, fine particulate matter, benzene, formaldehyde, industrial chemicals, heavy metals, radioisotopes, and more) are leaked, vented, flared, spilled, and dumped.


In 2016, The PediaBlog explored the “Trouble In The Gas Patch” and wasn’t surprised to learn that people get sick from the air pollution generated at fracking sites:


This week, the American Medical Association (AMA) released a long-awaited study that confirms what pediatricians, pulmonologists, and parents have been worried about for some time: the risk of developing asthma and needing asthma treatments is directly correlated to proximity to unconventional natural gas wells in Pennsylvania’s Marcellus gas patch.

By the time Templeton and Hopey were getting ready to publish “The Human Toll” in May 2019, health professionals working with residents in impacted communities were already alarmed by the accumulating research and what we were seeing on the ground. In a letter to the editor appearing in the Pittsburgh Post-Gazette, Sarah Rankin (a public health nurse working with Environmental Health Project) and I (EHP’s medical advisor) expressed our deep concerns and urged the Pennsylvania Department of Health to investigate why people living near fracking were getting sick:


It’s difficult to pinpoint the precise cause of such cancers, especially in a region with a long history of environmental pollution spawned by industry. We suspect that shale gas development may be a contributor. We and our research colleagues have found a striking correlation between shale gas development and a host of health problems, including asthma, skin rashes, stress, heart disease and birth defects, to name a few.


Regardless of the cause of these cancers, more research and study are surely warranted to protect the children and families living here. We implore the Pennsylvania Department of Health to investigate these reports of childhood cancer. If they are true, the state must take decisive and immediate action to lower the risk.

As stunning as “The Human Toll” was, it apparently wasn’t compelling enough to move the PADOH to action. In June 2019, I spoke at a public forum held in Canonsburg where Ewing sarcoma was diagnosed in six young people:


“There is something happening here in Southwestern Pennsylvania that is troubling and different — an inexplicable rise of cancer in the pediatric population — especially rare cancers like Ewing sarcoma. The numbers are alarming.


“Ewing sarcoma is literally one of those “one-in-a-million” type of diseases. Only about 200 cases are reported in the United States every year, with most occurring in older children, teenagers, and young adults. Bones in young people grow very rapidly. Bone cells are extremely active metabolically, which may help explain why exposure to environmental toxics make rare cancers like Ewing’s more likely to affect children.”

The following day, I traveled to Harrisburg and joined a group of public health advocates and impacted residents for a “Brown Bag Briefing” at the Statehouse, to educate lawmakers and deliver a letter to then-Governor Wolf demanding a scientific inquiry into Pennsylvania’s childhood cancer crisis. (Read my eyewitness account of the visit on The PediaBlog here).


Unfortunately, the governor’s response to our letter was weak — so weak, in fact, that on November 18, six months after the publication of “The Human Toll” and the nationwide attention it attracted, a larger group of health advocates, medical professionals, and residents, including parents who lost their children to Ewing sarcoma, returned to Harrisburg to confront the governor directly, in person, in the hallway adjacent to his office.



That trip to meet the governor face to face left an impression. Four days after our visit, Governor Wolf committed $3 million for the Pennsylvania Department of Health (PADOH) to study human health impacts related to fracking. After a several-months delay due to the start of the COVID-19 pandemic — around the same time a Grand Jury slammed the industry for the damage it was causing and excoriated both PADOH and Department of Environmental Protection for their poor response to Pennsylvanians who were suffering (read more about the Grand Jury’s findings and recommendations in “This Problem Won’t Fix Itself” on The PediaBlog) — researchers at the University of Pittsburgh Graduate School of Public Health were chosen to conduct three studies looking at the impacts from various environmental threats, including fracking, in eight southwestern Pennsylvania counties, on asthma incidence, birth outcomes, and cancer incidence in children.


Nearly four years after our demands for a scientific study were finally heard, and more than two years after the studies commenced, the University of Pittsburgh and PADOH will reveal what they learned tomorrow at 6:00 pm on the campus of PennWest California University. In addition to the in-person meeting, a virtual option is being offered for people who can’t attend in person. The University of Pittsburgh provides all the details about tomorrow’s meeting, including the link to the livestream, here.


No one should expect Pitt’s researchers to drop bombshells tomorrow evening. After all, epidemiological studies are not designed to find evidence of causation, something we discovered on The PediaBlog at the start of this odyssey (“Where Are You Going To Go?”):


Before pointing fingers and laying blame at the feet of the usual suspects, it’s important to remind ourselves that affixing causation on health conditions like cancer can be extremely difficult. What pediatricians are really interested in is correlation (what increases the risk of developing cancer in children) rather than causation, which is almost impossible to prove anyway since one cannot ethically conduct a prospective, randomized study on exposure and outcomes. [For example, researchers don’t expose 20 people to benzene, a known carcinogen, and wait to see what happens. Correlation is evidence enough to guide medical providers in the care of their patients.]


Instead, expect the findings to be consistent with the results of dozens of other epidemiological health studies (and more than 2,000 other scientific studies, government reports, and media investigations contained in the fracking science Compendium, published by Concerned Health Professionals of New York and Physicians for Social Responsibility) showing an association between living near fracking sites and harms to health (human and non-human), the environment, and the planet’s climate system. Because no study is perfect and every study has limitations (you can be sure critics will point them out), additional studies will be called for. That’s how science works.


Regardless of the studies’ conclusions, there is already enough solid, objective evidence telling us — doctors, nurses, parents — that fracking is inherently dirty and dangerous, making it impossible to be done safely here or anywhere. We already know beyond a reasonable doubt that fracking scars the landscape and degrades the environment. It pollutes the air, water, and soil we all depend on with toxic chemicals and radiation. It threatens the health of wildlife, aquatic creatures, farm animals, and family pets. Because methane leaks like crazy from fracked gas infrastructure — from the wellhead to the pipelines to your kitchen’s gas stovetop — it is known beyond a reasonable doubt that fracking accelerates climate change. And finally, after reading the growing mountain of evidence in the Compendium and talking to people who have been impacted by living and working near shale gas development in Pennsylvania — our neighbors, our friends, our patients, and perfect strangers — now we know that fracking makes people sick and puts children at risk.


I will be at the meeting tomorrow night at PennWest Cal U to listen to the carefully prepared and professionally delivered presentations from the Pitt research team and the PA Department of Health. I will be there to ask questions and to help people understand what they are hearing. But, mostly I will be there to add my support to all the people I have met over the last several years — children and adults, your neighbors and mine — who live and suffer near where the industry operates.


I will be there for them. Here is your invitation.


Previously published on Pediablog.

Dr. Ketyer is the social media medical advisor for AHN Pediatrics and editor of The Pediablog. He is also a member of the American Academy of Pediatrics Council on Environmental Health and Climate Change, medical advisor for Environmental Health Project, president of Physicians for Social Responsibility Pennsylvania, and Education and Outreach Workgroup chair for Cancer & Environment Network of Southwestern Pennsylvania. Dr. Ketyer served on the University of Pittsburgh’s External Advisory Board for the three studies, from June 2021 until his resignation from the board in October 2022.


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