## Health Professionals' Open Letter to Policy Makers in Support ofthe Clean Air Act and the Environmental Protection Agency

As physicians, nurses, and public health experts, we urge our policy makers to support the Environmental Protection Agency's (EPA's) ability under the Clean Air Act to take action that will protect public health and address climate change. Climate change poses significant threats to the health and well-being of all Americans, with disproportionate impacts on children, the elderly, and the poor
. Our own medical journals1' 2' 

### 3 '4 ' 5 

### and professional organizations (such as the American Medical Association, 6 

### American Academy of Pediatrics/ American Public Health Association, 8 

### and American Nursing Association 9 ) 

### have sounded the alarm. Health effects will include heat-related illnesses, exacerbated cardiovascular and respiratory diseases, more frequent outbreaks of water-borne diseases (such as Cryptosporidium) 

### and vector-borne diseases (such as West Nile virus), and mental health impacts result
ing from the stress of coping with extreme weather including flooding and hurricanes.10 The human and economic costs of these impacts are grave
. For instance, a recent report from the Union of Concerned Scientists estimates that in 

### 2020, the continental United States could pay an average of $5.4 billion (in 

### 2008 dollars) in healthrelated costs due to the increase in surface-level ozone associated with rising temperatures. 11 On April 

### 2, 2007, the Supreme Court ruled that global warming emissions are air pollutants covered by the Clean Air Act (CAA). 12 

### Subsequently, the EPA performed an exhaustive review of the relevant scientific research and determined that global warming emissions endanger public health and welfare and therefore must be regulated under the CAA. 13 Because the EPA's finding is based on well-established science, any effort to prevent or delay the agency from taking action to reduce global warming emissions is a rejection of that science. The EPA is charged with protecting our public health and our environment, and the Clean Air Act is an extraordinarily successful and cost-effective way of doing so. In 

### 2010 alone, this science-based law prevented an estimated 

### 160,000 premature deaths and millions of cases of respiratory and cardiovascular disease-annual benefits that are projected to grow during the next decade. The Clean Air Act is also good for the economy, with its benefits exceeding its costs by 

### 26 to 

### 1. 14 

### Now the EPA must be allowed to act on its authority under the law and begin regulating global warming emissions. Keeping in mind the urgency of America 's climate and energy challenges, the prohibitive cost of inaction, and the many benefits of acting today , we urge you to oppose all attacks on the Clean Air Act. Please respect the scientific integrity of the EPA's endangerment finding and the agency's ability to act based on this finding, and stand up for the public health and economic good of our nation.

### ENDNOTES 

## Health Professionals' Open Letter to Policy Makers in Support ofthe Clean Air Act and the Environmental Protection Agency

1. Costello , A., et al. 2009

. Managing the health effects of climate change. The Lancet 373 (9676):1693-1733

. May 16. 2

. Epstein, P

. R. 2005

. Climate change and human health

. New England Journal ofMedi c

ine 353: 1433 -143 6

. October 6

. 3

. Ha i nes, A ., and J.A

. Patz

. 2004

. Health effects of cli mate change. Journal of the Ameri can Medical Association 291:99-103. January 7. 4

. Rom , W

. N

. 2008

. Global warm i ng : A challenge to all American Thoraci c Society m e mbe rs
. Ameri can Journal ofRespiratory and Critical Care Medicine 177 : 1053-1054. 5

. Shea , K

. M

. 2007

. Global climate change and children 's health

. Pediatrics 120 : e1359- e1367

. October. 6. Ameri can Medical Association. 2008. Report 3 of the Council on Science and Publi c Health

. Online at http :// www
.ama -assn
.org /resources /doc j csaph /csaph3i08-summary

.pdf. 7. American Academy of Ped iatrics. 2007

. Global Cl i mate Change and Ch i ldren's Health. Online at http :// aappoli cy.aappublications

. org / cgi /reprint /pediatrics; 12 0 / 5 / 1149.pdf

. No
vember 2007

. 8

. Ameri can Public Health Association

. 2007

. Addressing the urgent threat of global climate change to publi c health and the environment. November 6. Online at http: // www
.apha

. org / advocacy j poli cy

j policysearch /default

. htm?id=135 1. 9. American Nurses Association. 2009. ANA caution s about health effects of climate change at press confere nce. November 23

. Online at http :// www
.nursingw orld.org / MainMenuCat egories / Occupati onalandEnvironmental /environmentalhealth /HealthProfessions-Speak-Out-About-Ciimat e-Change.asp x
. 2009. 10. Physicians fo r Social Respon si bility. No date. The medical and publi c health impact s of global warming. Online at http :// www
.psr
. org /asset s/

pdfs /global
- warming-fact-sheet.pdf

. 11

. Union of Concerned Scientists

. 2011. Climate change and your health: Rising tempera
tures, wor sening ozone pollution

. Online at http :// www
. ucsusa
. org / climatechangeandozonepollution. 1 2

. Massachusetts v
. EPA, 549 U.S

. 497 (2007)

. Text of opinion onl i ne at http :// www.supr em ecourt.gov /opinions / 06pdf / 05
- 11 2 0.pdf. 13. U

. S

. Envi ro nme ntal Prot ectio n Agen cy (EPA)

. 2009. Endange rment and cause or contrib
ute find i n gs fo r g reenh o use gases under Section 202(a) of the Cl ean Air Act

. Online at http :// www.e pa
.gov /climatechangej endangerment.html

.

## Health Professionals' Open Letter to Policy Makers in Support ofthe Clean Air Act and the Environmental Protection Agency

The signers ofthis statement are physicians , registered or advanced practice nurses, or e x

perts with a master ' s or Ph

. D. in public health. * denotes convening signer.


### A COMPLETE LIST OF THE 357 SIGNERS

ALASKA Jill Seaman, MD Bethel, AK ALABAMA David Smith, MD Spanish Fort, AL ARKANSAS Hosea Mcadoo, MD Sherwood, AR ARIZONA Mark Brown, MD Tucson , AZ Gerald Karches, MS Tucson, AZ M. Elizabeth Hunter, MPH Phoenix, AZ Ulrich Michael, MD Tucson, AZ Linda Smith Schermer, MPH Sedona, AZ Eve Shapiro, MD Tucson, AZ Barbara Warren, MD Tucson, AZ CALIFORNIA John Ackerman, MD Santa Barbara, CA Z ia Ahari, MD San Rafael, CA Ed Avol, MD Los Angeles, CA Jerald Abajian, MD Napa,CA Barbara Baehr, MD San Diego , CA Laura Balestreri, MD Oakland, CA Ann Blake, P hD Alameda, CA Ronald Blond , MD Rancho Palos Verdes, CA James Bronk, MD Napa, CA Elizabeth Carlton, PhD Oakland, CA Donna Carr, MD Encinitas, CA Jiu-Chiuan Chen, MD, MPH , SeD Los Angeles, CA Edward Cruz, MD Davis, CA Phyllis Cullen, MD Chico, CA Stanley Dawson, PhD Davis, CA Edward Cruz, MD Davis, CA George Ellison, MD San Diego, CA Jessica Fielden, MD Oakland, CA Austin Fite, MD Pacific Palisades, CA Charles Fischer, MD San Rafae l, CA Cheri Forrester, MD Mill Valley , CA Roger Fox, MD Carlsbad, CA Kenneth Frausto, MD Oakland, CA Maria Garcia, MD San Francisco, CA Warren Gold, MD Mill Valley, CA Nayvin Gordon, MD Oakland, CA Omar Guzman, MD Fresno, CA Timothy M

. Hall, MD, PhD , MA Los Angeles Jerome Hoffman, MD Beverly H ills, CA Martin Joye, MD Vacaville, CA Betty Jung, RN, MPH Oakland, CA Thomas Knecht, MD Oakland, CA James Koss, MD Richmond, CA Jeffrey Kupperman, MD Santa Barbara, CA Donald Lahti, MD Beaumont, CA

## Health Professionals' Open Letter to Policy Makers in Support ofthe Clean Air Act and the Environmental Protection Agency

Piper Lillehoff, MD Irvine, CA Robert Lowen, MD Pal o Alto, CA Erica Lubliner, MD Los Angeles, CA Richard Maddock, MD Davis , CA Teresa McColley, RN Santa Rosa , CA Robert Meagher, MD Sacramento , CA Lloyd Peck ner, MD Santa Monica, CA Dennis Pocekay Petaluma , CA Stephen Read, MD San Pedro, CA Sidney Reiff, MD Beverly Hills, CA Linda Rosenstock, MD, MPH* Los Angeles, CA Kathy Ruppel , MD Stanford, CA Fredrick Seil, MD Berkeley, CA Dan iel Silver, MD Los Angeles, CA Gina Solomon, MD, MPH San Francisco, CA Robert Spear, PhD Berkeley, CA Mark Spohr, MD Tahoe City, CA Arthur Strauss, MD Irvine, CA Carl Sufit, MD Escalon, CA Robert Sullivan , MD Sacramento, CA M

. Kelly Sutton, MD Fair Oaks, CA Jon Trefil, MD Albion, CA Harry Wang, MD Sacramento, CA Stephen Weber, MD Sa cramento , CA Mel Werbach, MD Springville, CA Junfeng (Jim) Zhang, PhD Los Angeles, CA COLORADO Wayne Crill, MD Fort Collins, CO Kenneth Kutalek, MD Evergreen, CO Michael Paterson, MD Monte Vista , 

## co Laurel Starr, MD Go lden, CO Huibert Vriesendorp, MD Silverthorne , 

## co CONNECTICUT Kathleen Cooper-McDermott, MSN,MPH Groton, CT Michael Corjulo, APRN North Haven, CT Vitto ria Gassman , MD Norwalk, CT J. Michael Herr, MD West Hartford, CT Peter Kennedy, PhD West Hartford, CT Ruth Knollmueller, RN, PhD Cheshire, CT Mark Mitchell, MD, MPH Hartford, CT Justin Paglino, MD Guilfo rd, CT Jonathan Stolzenberg, MD West Hartford, CT John Strauss , MD New Haven, CT Carolyn Jean Webb, SM, MS West Hartford , CT Faith Weidner, MD Simsbury, CT Moni ca Wheeler, MSN, RN Westport, CT DISTRICT OF COLUMBIA Tee Guidotti, MD, MPH Washington, DC DELAWARE Alyssa Pensirikul, MD, PhD Wilmington , DE FLORIDA Ph ilip Blaustein, MD Parrish , FL Raymond Bellamy, MD Tallahassee, FL Alan Delamater, PhD Plantation, FL

## Health Professionals' Open Letter to Policy Makers in Support ofthe Clean Air Act and the Environmental Protection Agency

Barrett Di ck, MD Bradenton, FL Sandra Gompf, MD Plant City , FL Marybeth Palmigiano , MPH Tampa, FL Cynthia Tainsh, MD Orlando , FL GEORGIA Vernon Di xo n, MD Hiawassee, GA Gail Heaberg, APRN Warner Robins, GA Jeremy Hess, MD, PhD Decatur, GA Karen Levy, PhD Atlanta, GA Gary Ludi , MD Roswel l, GA Michele Marcus, PhD Atlanta, GA Michael McGeehin , PhD, MSPH Atlanta , GA J Paul Newell, MD Cartersville, GA Justin Remais, PhD Atlanta, GA HAWAII Sue Felt, RN , MS, MPH Ka i l ua Kana, HI IDAHO Glen Albertson, MD Twin Falls, ID ILLINOIS Neil Aronson, MD Skokie, IL Carmen Del Cid, CPNP Ch icago , IL Linda Forst, MD, MPH Chicago, IL Jill Fraggos , MPH Ch icago , IL David Ganch, MD Chicago , IL Miche le Kelley, SeD Chicago, IL Kristine Kristine, APN Chicago, IL Karen Manning, NP Lisle, IL Dana March, PNP Chicago , IL Marvin Makinen, MD Chicago, IL Susanna McColley, MD Chicago, IL Rachel Rubin, MD Chicago, IL Barbara Sargent, PNP Libertyville , IL Jennifer Weuve, SeD, MPH Chicago , IL Eric Wilson, MD Chicago, IL INDIANA Denise Ward, DO Bristol, IN Howard Christofersen, MD Porter, IN Richard Newcomb, MD Portage , IN KANSAS Ann Suellentrop , MS, RN Kansas City, KS KENTUCKY Keisa Bennett, MD, MPH Lex ington, KY Virg i nia Bush, RN Louisville, KY Denise Puthuff, MD Lou isv ille, KY MASSACHUSETTS Wi lliam Abend, MD Wellesley H i lls, MA Melissa Bartick, MD Cambridge, MA Doris Berger, MD Brookline, MA Suzanne Cashman, SeD Newtonville, MA Stephanie Chalupka, EdD , APRN Worcester, MA David Christiani, MD, MPH, MS Boston, MA Trina Cysz, RN, MPH Bel chertown, MA Paul Epstein , MD , MPH deceased* Boston, MA Janna Gaberman, MD Longmeadow, MA Arthur Gionti, MD Amherst, MA Rose H

. Goldman , MD , MPH Cambridge, MA

## Health Professionals' Open Letter to Policy Makers in Support ofthe Clean Air Act and the Environmental Protection Agency

Barbara Goldoftas, PhD Viviana Cuberos, MD Howard Hu, MD, MPH, SeD * Worcester, MA Baltimore, MD Ann Arbor, MI Pamela Grace, PhD, APRN Laurette Cucuzza, MPH Larry Junek, MD Chestnut Hill, MA Silver Spring, MD Ann Arbor, MI Beverly Hector-Smith, NP Monique Dubois-dalcq, MD Shawn Kimmel, PhD, MA Natick, MA Bethesda, MD Detroit, MI Ben Kerman, MD Kelly Fritz, MD Kenneth Rosenman, MD Arlington, MA Leonardtown, MD East Lansing, MI Gera l d Keusch, MD L orne Garrettson, MD MINNESOTA Boston, MA Sandy Spring, MD Ann Bajari, M PH Nathaniel Kuhn, MD Katie Huffling, MS, RN, CNM Annanda le, MN Belmont, MA Mount Rainier, MD David Councilman, MD Charles Lidz, PhD Mary Lo, MD Minneapolis, MN Sutton, MA Germantown, MD Debora h Mielke, MD Jack Paradise, MD Thomas Moench, MD Mapl e Grove, MN Belmont, MA Balti more, MD MISSOURI Robert Petersen, MD Cindy Parker, MD, MPH Cambridge, MA Baltimore, MD Lester Bickford, MD Kansas City, MO James Philip, MD Liz Perera, MPH Joan Butcher, MD Chestn ut Hi l l, MA Bethesda, MD Saint L ouis, MO Christine Rogers, PhD Minerva Romero Arenas, MD Carmen Federowich, MD Amherst, MA Ba ltimore, MD Monroe City, MO Beth Rosenberg, SeD, MPH Mario Teran, MD Somervil le, MA Baltimore, MD MISSISSIPPI Jeffrey Scavron, MD MAINE Janet Black, BSN, MSN, MP H Springfield, MA Janet Ordway, MD Hattiesburg, MS Kathleen Szegda, MPH, MS Old Orchard Beach, ME Swink Hicks, MD Springfield, MA Edward Wa l worth, MD Madison, MD Bruce Wintman, MD Lewiston, ME MONTANA Springfie ld, MA MICHIGAN Kathleen Masis, MD MARYLAND Stuart Batterman, PhD Billings, MT Brenda Afza l , RN, MS Ann Arbor, MI NORTH CAROLINA Ellicott City, MD Alfred Franzblau, MD Alan Archbold, DO Karyn Anderson, PhD, MD Ann Arbor, MI Hillsborough, NC Baltimore, MD Joseph Hess, MD William Blackley, MD East Lansing, MI Elkin, NC

## Health Professionals' Open Letter to Policy Makers in Support ofthe Clean Air Act and the Environmental Protection Agency

Deborah Fields , MD Greensboro, NC Priscilla Guild, MSPH Chapel Hill, NC Jonathan Kotch, MD Du rham, NC Jack Leiss, PhD Mebane, NC Thomas Mutton, MD Winston Salem , NC Donna Newman, PhD Raleigh, NC Lewis Patrie, MD Ashev ille, NC Martha Payn e, PhD, MPH Durham, NC Karin Yeatts, Ph D Chapel Hill, NC NEW HAMPSHIRE Phillip Hunt , SeD Newfields, NH Michael OSullivan, PhD Madbury, NH Nathan Sidley, MD Wonalancet, NH Mark Windt, MD North Hampton, NH NEW JERSEY Karen KellyThomas, PhD , RN Gibbsboro, NJ Jud ith Klotz, DrPH , MPH Lawrenceville, NJ Luis Montesinos, MD Little Falls, NJ Marian Nowak, MEd, MSN, MPH Sicklerville, NJ Joseph Ponessa, PhD, MS Moorestown, NJ Ninu-Aiexandri Quirk, MD Deal, NJ Derek Shendell, DEnv, MPH Chatham, NJ Mary Ellen Teshima, RN Towaco, NJ Michael Yellin, MD Montclair, NJ NEW MEXICO Eileen Barrett, MD Shiprock, NM Robert Bernstein, MD Santa Fe, NM Yadira Caraveo, MD Albuquerque, NM Gene Chorostecki , MD Santa Fe, NM Anita Holtz, MD Albuquerque , NM Norton Ka l ishman, MD Albuquerque, NM Barry Kirschbaum, MD Santa Fe, NM Jean MacPhail, MD Santa Fe, NM Stephen Markowitz, MD Santa Fe , NM Jam es Montesinos, MD Santa Fe , NM James Sitrick Jr, MHSc Santa Fe, NM Jon Spar, MSPH Albuquerque, NM Barba ra Starfie ld, MD deceased Las Cruces, NM Alex Stelzne r, MD Albuquerque, NM NEVADA James Lawrie, MD Reno, NV Nancy Menzel, RN, PhD Las Vegas, NV William Schaffer, MD Las Vegas , NV NEW YORK Carl W

. Braun, MD New York, NY Norma MT Braun, MD Thornwood, NY Joan Budd, MD Pleasantville , NY Cenie Cafarelli, MD Rochester, NY Vanessa Calderon, MD Ithaca, NY Megan Cea, MD White Plains, NY Gordon Comstock, MD Arcade, NY Margaret Craven, MD Voorheesville, NY Dominic Ferro, MD Nanuet, NY Frederic Joyce, MD Utica, NY Joseph Graziano, PhD New York, NY

## Health Professionals' Open Letter to Policy Makers in Support ofthe Clean Air Act and the Environmental Protection Agency

Jessica Kande l , MD Jason Chao, MD Theodore Nichols, MD New York, NY Cleveland , OH Painesville, OH Andrew Kanter, MD , MPH Elaine Connelly, RN Barbara Polivka, PhD New York, NY Broadview Heights, OH Columbus, OH Elizabeth Kinney, MS Kim Conway, RN Chris Rea , MPH Albany, NY North Royalton, OH Columbus, OH Gerald Kolbert, MD An ne Davy , RN, MS Ann Reichsman, MD Larchmont, NY Prospect, OH Cleveland Heights, OH Phi lip Landrigan, MD, MSc Daniel Dawley, MD Susan Righi, MD New York, NY Bowl ing Green, OH Athens , OH Gerson Lesser, MD Chantal Dothey, MD Jonathan Slaughter, MD Bron x, NY Cleveland, OH Bexley, OH Jaymie Meliker, PhD Therese Dowd, PhD , RN Julia Veres, MSN Port Jefferson, NY Akron, OH Cleveland Heights, OH Jill Nord, MD Lois McClelland, RN Ann Wi lliams, MD Glendale , NY Sheffield L ake, OH Cleveland Heights, OH Stacey Plichta , SeD Theodore Nichols, MD Chadw ick Wright, MD New York, NY P ainesvi lle, OH Lew is Center, OH
Ri chard Schloss, MD Barba ra Polivka , PhD OKLAHOMA Huntington, NY Columbus, OH G. Edward Sh issler, MD Mary Ann Segal, MD Chris Rea, MPH Edmond , OK Bronx, NY Columbus , OH OREGON Vincent Silenzio, MD, MPH Ann Reichsman, MD Stephen Bachhuber, MD Rochester, NY Cleveland Heights, OH Hap py Valley , OR Sayone Thihalolipavan, MPH Susan Righi, MD Ni cholas De Morgan, M D New York, NY Athens, OH Portland, OR Ruth Wal ker, MD, PhD . Jonathan Slaughter, MD Martin Donohoe, MD Brooklyn , NY Bexley , OH Lake Oswego, OR Mark Wel ler, MD Julia Veres, MSN Nancy Loeb, MD Scarsdale, NY Cleveland He ights, OH Portland , OR OHIO Ann Williams, MD Jenny Pompilio, MD Mary Brown , MPH Cleveland Heights, OH Portland , OR Morrow, OH Chadwi ck Wright, MD Berklee Robins, MD Timothy Buckley, PhD * Lewis Center, OH Lake Oswego, OR Columbus, OH

## Health Professionals' Open Letter to Policy Makers in Support ofthe Clean Air Act and the Environmental Protection Agency

Irene Saikevych, MD Talent, OR

Catherine Thomasson, MD Corvallis, OR PENNSYLVANIA Nicholas Abend, MD Philadelphia, PA Jeffrey Bedrick, MD Newtown Square, PA Cheryl Bettigole, MD Philadelphia, PA Lisa Evans, MD Philadelphia, PA Arthur Frank, MD, PhD Philadelphia, PA Bernard D. Goldstein, MD Pittsburgh, PA George Leikauf, PhD Pittsburgh, PA Felicia Lewis, MD Philadelphia, PA Walter Margie, MD Bethlehem , PA Dora Martinez-Armstrong, RN Philadelphia, PA Mark Mishkin, MD Philadelphia, PA Marvin Rosenthal, MD Easton, PA Michael Rusli, MD Hum melstown, PA Walter Tsou, MD, MPH Philadelphia, PA D. Sandra Whipple, MD Merion Station, PA RHODE ISLAND Polly Walker, MD, MPH Rumford, RI SOUTH CAROLINA Cynthia Schandl, MD, PhD Charleston, SC SOUTH DAKOTA John Whitney, MD Rapid City, SD TENNESSEE David Head, MD Nashville, TN Linda Head, RN Nashville, TN F. Menking, MD Nashville, TN Joan Mitchell, RN, MPH Hermitage, TN David N. Orth, MD Nashville, TN Dow Strader, MD Bristol, TN TEXAS John Calomeni, MD Lajitas, TX Miguel Fernandez, MD San Antonio, TX Ronald Fisher, MD Houston, TX Diane Graves, MPH Austin, TX Paul Mayer, MD Livingston, TX Lynnette Mazur, MD, MPH Houston , TX Celeste Monforton, DrPH, MPH San Marcos, TX

Marian Morris, MD, MPH Austin , TX Arnold Schecter, MD, MPH Dallas, TX Carolina Young-Ortiz, MD Houston , TX UTAH Sherman Bl oom, MD Salt Lake City, UT Cris Cowley, MD Cottonwood Heights , UT Dirk Davis, MD Logan, UT Richard Kanner, MD Salt Lake City, UT Brian Moench, MD Salt Lake City, UT Anthony Musci, MD Salt Lake City, UT Suzanne Stensaas, PhD Salt Lake City, UT VIRGINIA Laura Anderko, PhD, RN Annandale, VA Kenneth Ballew, MD Ivy, VA Virginia Barber, MD Crozet, VA Larry K

. Heath, MD Broad Run, VA George Hoke, MD Charlottesville, VA

## Health Professionals' Open Letter to Policy Makers in Support ofthe Clean Air Act and the Environmental Protection Agency

Irma Mahone, PhD, RN Mary Hutchison , NP Bruce Krawisz, MD Charlottesville , VA Seattle, WA Marshfield, WI Steve Kohl, MD Jed Maker, MD Marcia McDuffie , MD Brush Prairie, WA Milwaukee, WI Roseland, VA Jeffrey Paul LaGasse , MD Wanda Martinez, MD Mary Pi cardi, MD Freeland, WA Milwaukee, WI Virginia Beach, VA Ralph Myer, MD Dennis Ryan, MD Pellavi Sharma , MPH Seattle, WA La Crosse , WI Arlington , VA Tracy Ouellette , MD Richard Schmelzer, MD Surili Sutaria, MS Bow, WA Madison, WI Arlington , VA Robert Stagman, MD Peter Sigmann, MD David Williams , MD , PhD Mercer Island, WA Sturgeon Bay, WI Midlothian, VA 

### WISCONSIN Joseph Thompson , MD 

### WASHINGTON Robert Block, MD Tigerton, WI John Butler, MD Madison , WI Erika Voss, RN Lake Forest Park, WA Mary Canales , PhD Wauwatosa, WI Sari Lisa Da vison, MD Eau Claire , WI 

### WEST VIRGINIA Seattle , WA Derek Clevidence, MD Sarah Knox, PhD, MS Jerrold Eichner, MD Cottage Grove, WI Morgantown, WV Seattle , WA Theresa Guilbert, MD Howard Frumkin, MD, MPH * Madison , WI Seattle, WA



### * denotes convening sig ne r Thi s letter was co mpiled by the Union of Concerned Scientists on behalf of the sig ners
.



# Union ofConcerned Scientists Citizens and Scientists for Environmental Solutions