Sick Building Syndrome: Floods, Mold, Cancer, and the Politics of Public Health

by Ritt Goldstein

It's spring, and flooding is again making headlines, although the 'sick building' and mold dangers following in flooding's wake are becoming better appreciated. But disturbingly highlighting the imperatives of such awareness, recently published research has - for the first time - shown the high cost of what the sickness that comes of 'sick buildings' can mean, with the potential for long-lasting disability now being a documented fact.

According to a ground breaking Swedish study appearing in The International Archives of Occupational and Environmental Health, 45% of so-called 'Sick Building Syndrome' (SBS) victims - treated at hospital clinics - no longer have the capacity to work. Twenty percent of these sufferers are receiving disability pensions, 25% are "on the sick-list". Emphasizing SBS's devastating potential, the study warned that the possibilitiy "of having no work capabilities at follow up was significantly increased if the time from (SBS) onset to first visit at the hospital clinic was more than 1 year. This risk was also significantly higher if the patient at the first visit had five or more symptoms."

It's unfortunate that knowledge of the serious nature of SBS has not emerged sooner. But, as highlighted by the US Department of Veteran's Affairs during last Fall's revelations upon Gulf War Illness, sometimes political and economic considerations affect health policy, leading to a serious health issue long being "denied" or "trivialized".

‘Sick Building Syndrome' (more precisely termed ‘non-specific building-related illness') is typically a product of breathing indoor-air contaminated by mold and/or chemical toxins. Things such as flooding, or poor building contruction, design, or ventilation, can bring on the problem.

SBS's symptoms have been known to include: mucus-membrane irritation, neurotoxic effects, respiratory symptoms, skin symptoms, gastrointestinal complaints, and chemosensory changes. And while the malady has been increasingly seen since the 1970's, when energy concerns led to the reduction of indoor ventilation by as much as two thirds, the Swedish study is thought to be the first where the problem has been demonstrated as a chronic condition sparked by environmental causes.

The study was performed by scientists at the Academic Hospital of the University of Umeå, in Northern Sweden, and was based upon locally derived data. But while differences in disability laws and culture may exist between any two nations, as the study strongly observed: "symptoms aggravated by environmental factors exist within this group of patients".

Providing an interesting parallel, in the aftermath of Hurricane Katrina the New Orleans area saw the phenomenon of ‘Katrina Cough' occur; a phenomenon marked by a number of SBS symptoms. Though Louisiana health authorities have been dismissive of the ‘Cough', at present Tullane University School of Medicine has received funding for a five-year study, Tullane's newspaper headlining: "Researcher Seeks Truth About ‘Katrina Cough'".

Unfortunately, even problems more serious than SBS can occur through mold, the US Environmental Protection Agency's (EPA) website explicitly warning that the inhalation of mycotoxins (toxins naturally occurring in some species of molds) has been reported to cause maladies that include cancer. Illustrating what this can mean, recent Swedish headlines shocked the Scandinavian Peninsula with news of just such a cancer outbreak.

Strömbackaskola, a high school in the Northern city of Piteå, was the scene of the cancer cluster. In the worst affected area, about 40% of the employees have been stricken with the disease, with the local paper headlining "The mold in the school is cancer causing", a national headline reading "Mold in school gives teachers cancer".

Though the cancer cases began appearing years ago, and its cause was earlier investigated, it was only recently that ‘toxic black mold', Stachybotrys, was found in the affected areas.

Perhaps even more disturbing, while some claim tragedies like this are unforeseeable, others see them born of a misguided defense of past mistakes, with indifference, and even occasional tactics of intimidation, nurturing tragedy. No land is immune to the temptations of politics and economics...and no land is immune to cancer.

As early as 1999, findings of an association between inhaled mycotoxins (such as aflatoxin) and cancer were reported by the National Institute for Occupational Safety and Health (NIOSH), their study noting: "Several studies have provided evidence for the association of cancer in humans with inhalation of aflatoxin contaminated dust, e.g., lung cancer or colon cancer...elevated risks for liver cancer and cancers of biliary tract". Similar to the EPA, the NIOSH study further warned: "Diseases associated with inhalation of fungal spores include toxic pneumonitis, hypersensitivity pneumonitis, tremors, chronic fatigue syndrome, kidney failure, and cancer."

It is regrettable that one can only speculate upon what the true incidence of mold-related cancer, and other mycotoxin-related illness, may be, both in the US and abroad.

While an American, I live in Sweden and have for the last twelve years. Perhaps because Sweden isn't a large nation, Swede's social activism, their relationship with their government, communities, and each other, is considerably stronger than that I once knew. But, despite this...

In an article published this summer upon Sweden's ‘sick schools' - in Scandinavia's largest daily, Aftonbladet - I had emphasized that mold can indeed cause maladies ranging from asthma to cancer. But as early as 1997, Stockholm's papers were already broaching questions of 'sick building' related cancers, questions which seem to have been ignored.

At that time, Swedish toxicologist Tony Kronevi was widely quoted as warning of a potential "cancer explosion" resulting from "sick buildings in Sweden". He specifically warned of problems with "sick schools", urging that people take "this problem seriously. Now."

It's unfortunate that, despite such warnings, this past summer a Swedish government report revealed that those at the national level had yet to take sick schools "seriously." Just months later, in December, news of the cancer cluster broke.

Was this an instance of political and economic considerations affecting health policy? Was a serious health threat long "denied" or "trivialized"?

Further highlighting what some here have termed ‘indifference', Swedish parliamentarian Jan Lindholm (Green Party) observed that, for him, it's "totally inconceivable that the government shows no interest in finding out how over 20 people in a workplace (Strömbackaskola) came to be smitten by cancer". He added, "this Government is the landlord's government."

Approximately a week before news of Strömbackaskola's cancer outbreak broke, the Swedish Minister for Public Health told Swedish National Radio that she believed the link between poor indoor air and poor health was too weak to act upon.

Reflecting the Minister's position, Sweden's governmental websites lack the kind of mold and ‘sick building' warnings provided by entities such as the EPA and NIOSH, despite the recent SBS findings from Umeå and similar pronouncements from other scientists. Given this, it's particularly unfortunate that the very young are those most at risk from indoor air problems.

Last Fall I interviewed one of America's leading authorities on mold - Dr. Dorr Dearborn, Chairman of the Department of Environmental Health Sciences at Case Western Reserve University School of Medicine. Dearborn came to national attention in 1997, The New York Times headlining "Infants' Lung Bleeding Traced to Toxic Mold", a revelation he was instrumental in bringing forward. Though his findings and those of his equally courageous colleague, Ruth Etzel, became the subject of considerable debate, the EPA's "Children's Health Initiative on Toxic Mold" continues to warn: "A cluster of cases of acute pulmonary hemorrhage/hemosiderosis was reported in Cleveland, Ohio, where 27 infants from homes that suffered flood damage became sick (nine deaths) with the illness starting in January 1993."

In the interim since his and Dr. Etzel's findings, animal studies continue to provide ever added confirmation of their conclusions upon toxic mold's dangers.

During the course of my interview with Dearborn, I asked what had occurred that took the momentum from the ‘sick building' and mold reforms which many then saw on the horizon. Emphasizing he could just speculate upon what factors had earlier impacted America's ‘mold debate', Dearborn spoke of "pressure from industrial sources - insurance companies, etc - to ‘back off' this problem."

In Sweden, people have spoken of the "gigantic costs" which addressing ‘sick buildings' would entail, and this has led many to rationalize away inaction accordingly. Of course, the costs of the widespread illnesses and property damage associated with ‘sick buildings' is thought to be even more substantive, though, far less visible and borne mainly by individuals, not business or government.

I won't point out that discussion of isolated cancer cases associated with sick buildings has barely begun here. Nor will I speculate upon the fate of those living in places like Herrgården, a large housing complex in Sweden's southern city of Malmö's Rosengård area, where - contrary to the Country's ‘squeaky clean' image - recent news stories revealed that half of the apartments are mold infested.

An interview with a number of Rosengård's healthcare workers recently appeared in local media. The ongoing tragedy they described isn't pretty.

Within the last twelve months, this nation of nine million has had at least three major residential housing scandals, each involving large numbers of families. And while roach infested slums have sadly now come to Sweden, two of the three scandals involved upscale developments - one was a community of villas on the Country's west coast, the other was waterside condos in Stockholm.

Of course, in the US, comedic icon Ed McMahon won a $7 million dollar judgment following his Beverly Hills home's mold problems. But just this March, the TV news program ‘Inside Edition' ran a story titled: "Did Mold Cause Ed McMahon's Life-Threatening Cancer?"

In Sweden, the widespread failure to adequately enforce safe-housing laws has been described as an ‘open secret'. In The States, the phrase ‘managed debate' is used to describe the process through which better regulation of ‘sick buildings' and mold is kept from even becoming law.

Both circumstances have a cost, and public health has paid dearly. Is Sweden's mold-associated cancer unique, or rather, is it unique only in that this instance of mold-associated cancer was so large that it could not be rationalized away, dismissed and ignored?

In a November article of mine - which was also published in Aftonbladet - I compared Sweden's ‘sick building' scandal to that of China's melamine. Both scandals are the product of what have been described as ‘open secrets', but according to a 2003 Swedish survey, sick buildings are sickening a vastly higher population percentage than melamine did.

While our globe is currently witnessing the havoc which lax regulation and unconscionable behavior meant for the financial markets, is this but one indicator of something ‘deeper'? America's ongoing prescription drug and food scandals, China's melamine, and Sweden's ‘sick building' scandal - all suggest that our ‘crisis' may be considerably broader than merely one of finance.

History has long demonstrated the high price of blind, ruthless ambition, a price which our world has perhaps only begun to realize it is now paying. Quoting Swedish parliamentarian Jan Lindholm, "totally inconceivable" well describes present circumstances.

We have a problem, a bad problem, and it has its causes. In example, Kronevi told me of a Swedish book he participated in on building issues, a book which might have started vigorous ‘sick building' debate years ago. He also provided copies of correspondence highlighting how the text had been effectively suppressed.

Of course, a passage from that book noted that a number of Swedish cities, "have noticed an unusually high number of cancer cases connected to SBS symptoms", with other passages equally interesting. What is also ‘interesting' are others who have described abuses of power, the efforts to stifle critical voices.

In 2004 I interviewed a number of leading US scientific figures, doing so while writing an exposé series on the drug industry. One article, "Intimidation, Politics and Drug Industry Cripple U.S. Medicine", contained several interviews worth revisiting.

Kathleen Rest, executive director of the Union of Concerned Scientists (UCS) - whose membership is comprised of much of the cream of America's scientific community, including a number of Nobel laureates - told me of a "pattern", a pattern of "politicizing or manipulating scientific advisory boards." She also noted the UCS had found "evidence and cases of agencies manipulating or suppressing scientific analysis."

Dr. David J. Graham, the courageous Associate Safety Director of the US Food and Drug Administration (FDA), separately added that "intimidation of scientists who threaten the status quo at FDA is routine."

It was just this summer when a Swedish environmental researcher - who spoke only under condition of anonymity - told me that challenging the Swedish status quo on ‘sick building' issues was almost like challenging the mafia. Other Swedes, from different perspectives, have spoken similarly. Leif Kåvestad - a former environmental inspector who received a personal award from the then Swedish Prime Minister, Göran Persson - is one of these.

Both Kåvestad and the researcher indeed described efforts aimed at intimidation, efforts sometimes undertaken by those pursuing self-serving denials of Swedish indoor-environment problems.

On a local level, Kåvestad spoke of how "community Health Departments often cooperate with the community housing companies and their consultants. Tenants which complain over sick buildings with health complaints are threatened...the parties together act like a mafia against the tenants." And while speaking generally, he added he's aware of this pattern at some of Stockholm's ‘sick buildings', and as an ombud has just taken the question before the Environmental Court.

There is good reason to believe that such circumstances are not limited to Sweden.

An SBS victim myself, I have just filed a civil suit against my landlord, Kopparstaden, a housing firm within the Swedish county of Dalarna. In 2007, my community's health department declared the apartment Kopparstaden had recently rented me to be uninhabitable.

To this day, my health remains shattered - I suffer a particularly nasty form of SBS.

When I arrived here, as a newcomer to the community, the local ‘Integration Authority' had offered me the flat. Though it had an unusual odor from the first time I saw it, I was told the odor would ‘disappear' when I used the plumbing.

When I asked to see other apartments, I was told by the Integration Authority that the apartment was ‘fine', that there were no others, and, if I didn't accept it, I wouldn't be offered another and would likely not find any apartment on my own. Given the circumstances, and that I had no reason to then disbelieve the assurances I was given, I took the flat accordingly.

Later, laboratory analysis revealed "powerfully elevated" mold levels and "unusually high levels" of chemical toxins - such as chloroform - were in every breath I took. According to my physicians, virtually all of my belongings must be disposed of because of contamination, and my insurance policy - as with most insurance policies today - does not cover this kind of claim. However, Kopparstaden's only compensation offer for my ruined property and shattered health was about $1,000. I refused it.

It is difficult for me to reconcile the many instances I've witnessed demonstrating Swedish society's honesty and integrity with the circumstances I describe.

While the US civil court system has awarded a number of ‘sick building' and mold sufferers millions of dollars in damages, such things do not exist in this country - there are no punitive damages in this legal system, court awards are ‘minimal'. And, despite such circumstances accentuating the need for robust enforcement of safe housing laws, the opposite appears to have occurred. But, this does well illustrate how the costs of ‘sick buildings' - though extremely substantive - are today borne mainly by individuals, not the businesses which provide ‘sick' properties, nor the governmental entities which allow them to continue doing so.

Is today's ‘crisis' far broader than merely finance? Has Public Health been sacrificed for political and economic motives?

While many have indeed called the widespread compromising and failure of regulatory authorities an ‘open secret', perhaps ‘national catastrophe' may well prove itself a far better term.

LINKS YOU MAY CARE TO USE   

• SBS Study - 45% Disabled http://www.ncbi.nlm.nih.gov/pubmed/17924130  
• "Researcher Seeks Truth About ‘Katrina Cough'" http://tulane.edu/news/newwave/010208_cough.cfm  
• EPA Mold Warnings - See "Mold Toxins (Mycotoxins)" http://www.epa.gov/mold/append_b.html  
• NIOSH Study Linking Mold with Cancer and other maladies http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1566211  
• The New York Times - "Infants' Lung Bleeding Traced to Toxic Mold" http://www.nytimes.com/1997/01/24/us/infants-lung-bleeding-traced-to-toxic-mold.html  
• EPA - "Children's Health Initiative on Toxic Mold" http://www.epa.gov/appcdwww/iemb/child.htm  
• Inside Edition - "Did Mold Cause Ed McMahon's Life-Threatening Cancer?" http://www.insideedition.com/news.aspx?storyID=2685
• "Intimidation, Politics and Drug Industry Cripple U.S. Medicine" http://www.commondreams.org/headlines04/1231-02.htm