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THE ENVIRONMENT AND HUMAN HEALTH: 

HHS’ ROLE 

HEARING 

BEFORE THE

SUBCOMMITTEE ON HEALTH 

OF THE

COMMITTEE ON ENERGY AND 

COMMERCE 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED ELEVENTH CONGRESS 

SECOND SESSION 

APRIL 22, 2010 

Serial No. 111–112 

( 

Printed for the use of the Committee on Energy and Commerce 

energycommerce.house.gov 


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COMMITTEE ON ENERGY AND COMMERCE 

HENRY A. WAXMAN, California, Chairman 

JOHN D. DINGELL, Michigan 

Chairman Emeritus 

EDWARD J. MARKEY, Massachusetts 

RICK BOUCHER, Virginia 

FRANK PALLONE, JR., New Jersey 

BART GORDON, Tennessee 

BOBBY L. RUSH, Illinois 

ANNA G. ESHOO, California 

BART STUPAK, Michigan 

ELIOT L. ENGEL, New York 

GENE GREEN, Texas 

DIANA DEGETTE, Colorado 

Vice Chairman 

LOIS CAPPS, California 

MICHAEL F. DOYLE, Pennsylvania 

JANE HARMAN, California 

TOM ALLEN, Maine 

JANICE D. SCHAKOWSKY, Illinois 

CHARLES A. GONZALEZ, Texas 

JAY INSLEE, Washington 

TAMMY BALDWIN, Wisconsin 

MIKE ROSS, Arkansas 

ANTHONY D. WEINER, New York 

JIM MATHESON, Utah 

G.K. BUTTERFIELD, North Carolina 

CHARLIE MELANCON, Louisiana 

JOHN BARROW, Georgia 

BARON P. HILL, Indiana 

DORIS O. MATSUI, California 

DONNA M. CHRISTENSEN, Virgin Islands 

KATHY CASTOR, Florida 

JOHN P. SARBANES, Maryland 

CHRISTOPHER S. MURPHY, Connecticut 

ZACHARY T. SPACE, Ohio 

JERRY MCNERNEY, California 

BETTY SUTTON, Ohio 

BRUCE L. BRALEY, Iowa 

PETER WELCH, Vermont 

JOE BARTON, Texas 

Ranking Member 

RALPH M. HALL, Texas 

FRED UPTON, Michigan 

CLIFF STEARNS, Florida 

NATHAN DEAL, Georgia 

ED WHITFIELD, Kentucky 

JOHN SHIMKUS, Illinois 

JOHN B. SHADEGG, Arizona 

ROY BLUNT, Missouri 

STEVE BUYER, Indiana 

GEORGE RADANOVICH, California 

JOSEPH R. PITTS, Pennsylvania 

MARY BONO MACK, California 

GREG WALDEN, Oregon 

LEE TERRY, Nebraska 

MIKE ROGERS, Michigan 

SUE WILKINS MYRICK, North Carolina 

JOHN SULLIVAN, Oklahoma 

TIM MURPHY, Pennsylvania 

MICHAEL C. BURGESS, Texas 

MARSHA BLACKBURN, Tennessee 

PHIL GINGREY, Georgia 

STEVE SCALISE, Louisiana 


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SUBCOMMITTEE ON HEALTH

FRANK PALLONE, JR., New Jersey, Chairman 

JOHN D. DINGELL, Michigan 

BART GORDON, Tennessee 

ANNA G. ESHOO, California 

ELIOT L. ENGEL, New York 

GENE GREEN, Texas 

DIANA DEGETTE, Colorado 

LOIS CAPPS, California 

JANICE D. SCHAKOWSKY, Illinois 

TAMMY BALDWIN, Wisconsin 

MIKE ROSS, Arkansas 

ANTHONY D. WEINER, New York 

JIM MATHESON, Utah 

JANE HARMAN, California 

CHARLES A. GONZALEZ, Texas 

JOHN BARROW, Georgia 

DONNA M. CHRISTENSEN, Virgin Islands 

KATHY CASTOR, Florida 

JOHN P. SARBANES, Maryland 

CHRISTOPHER S. MURPHY, Connecticut 

ZACHARY T. SPACE, Ohio 

BETTY SUTTON, Ohio 

BRUCE L. BRALEY, Iowa 

NATHAN DEAL, Georgia, 

Ranking Member 

RALPH M. HALL, Texas 

BARBARA CUBIN, Wyoming 

JOHN B. SHADEGG, Arizona 

STEVE BUYER, Indiana 

JOSEPH R. PITTS, Pennsylvania 

MARY BONO MACK, California 

MIKE FERGUSON, New Jersey 

MIKE ROGERS, Michigan 

SUE WILKINS MYRICK, North Carolina 

JOHN SULLIVAN, Oklahoma 

TIM MURPHY, Pennsylvania 

MICHAEL C. BURGESS, Texas 


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C O N T E N T S 

Page 

Hon. Frank Pallone, Jr., a Representative in Congress from the State of 

New Jersey, opening statement .......................................................................... 2 

Hon. John Shimkus, a Representative in Congress from the State of Illinois, 

opening statement ................................................................................................ 3 

Hon. Donna M. Christensen, a Representative in Congress from the Virgin 

Islands, opening statement ................................................................................. 5 

Hon. Jane Harman, a Representative in Congress from the State of California, opening statement .................................................................................... 6 

Hon. Marsha Blackburn, a Representative in Congress from the State of 

Tennessee, opening statement ............................................................................ 7 

Hon. John D. Dingell, a Representative in Congress from the State of Michigan, opening statement ....................................................................................... 8 

Hon. Kathy Castor, a Representative in Congress from the State of Florida, 

opening statement ................................................................................................ 9 

Hon. Phil Gingrey, a Representative in Congress from the State of Georgia, 

opening statement ................................................................................................ 11 

Hon. Henry A. Waxman, a Representative in Congress from the State of 

California, prepared statement ........................................................................... 57 

Hon. Anna G. Eshoo, a Representative in Congress from the State of California, prepared statement .................................................................................. 59 

Hon. Joe Barton, a Representative in Congress from the State of Texas, 

prepared statement .............................................................................................. 60 

WITNESSES

Linda Birnbaum, Director, National Institute of Environmental Health 

Sciences and National Toxicology Program ....................................................... 12 

Prepared statement .......................................................................................... 15 

Answers to submitted questions ...................................................................... 66 

Henry Falk, Acting Director, National Center for Environmental Health and 

Agency for Toxic Substances and Disease Registry .......................................... 22 

Prepared statement .......................................................................................... 24 


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THE ENVIRONMENT AND HUMAN HEALTH: 

HHS’ ROLE 

THURSDAY, APRIL 22, 2010 

HOUSE OF REPRESENTATIVES, SUBCOMMITTEE ON HEALTH, COMMITTEE ON ENERGY AND COMMERCE, Washington, DC. 

The Subcommittee met, pursuant to call, at 9:35 a.m., in Room 

2123 of the Rayburn House Office Building, Hon. Frank Pallone, 

Jr., [Chairman of the Subcommittee] presiding. 

Members present: Representatives Dingell, Shimkus, Buyer, 

Pitts, Myrick, Harman, Burgess, Blackburn, Barrow, Gingrey, 

Christensen, Barton (ex officio), Castor, and Sarbanes. 

Staff present: Kristin Amerling, Chief Counsel; Ruth Katz, Chief 

Public Health Counsel; Purvee Kempf, Counsel; Naomi Seiler, 

Counsel; Elana Stair, Policy Advisor; Allison Corr, Special Assistant; Greg Dotson, Chief Counsel, Energy and Environment; Melissa 

Cheatham, Professional Staff Member; Elizabeth Letter, Special 

Assistant; Earley Green, Chief Clerk; Mitchell Smiley, Special Assistant; David Cavicke, Minority Chief of Staff; Jerry Couri, Minority Professional Staff Member, Environment; Ryan Long, Minority 

Chief Counsel, Health; Krista Rosenthall, Minority Counsel, Oversight; Aarti Shah, Minority Counsel, Health; and Alan Slobodin, 

Minority Chief Counsel, Oversight. 

Mr. PALLONE. I call the meeting to order. Today the House Subcommittee is having a hearing on The Environment and Human 

Health: The Role of HHS, and I will recognize myself for an opening statement. 

Mr. SHIMKUS. Mr. Chairman, would you yield for a minute? 

Mr. PALLONE. Sure. 

Mr. SHIMKUS. Just parliamentary inquiry. Talking about slippery 

slopes. I am new in this. When is the Administration or anybody’s 

reports due to us prior to a Congressional hearing? Do you know 

what the rules say? 

Mr. PALLONE. I am not sure what you are asking me. 

Mr. SHIMKUS. When we ask people to testify before us, there is 

a requirement that they have their written submission so many 

days in advance or hours in advance. What might that be? 

Mr. PALLONE. I do not know. You are going to have to ask. When 

witnesses testify, when are they supposed to have their—we will 

have to find out for you. 

Mr. SHIMKUS. OK. The point being I think that obviously we got 

one submission at 8:30 last night, and we understand that a request to come before Congress is burdensome and you have to run 


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around a whole bunch of traps. But it is really not fair to our staff 

who has to read the reports and try to do preparation for their 

Members. In essence, you are condemning them to be here from 

8:00 until midnight in preparation for a hearing that starts at 9:30 

a.m. And so this will not be the first time it has happened, it won’t 

be the last time. But it is incumbent upon the loyal opposition to 

raise these issues which I would like to raise. 

Mr. PALLONE. I mean, I will find out when it is supposed to be, 

but I think we should have them at least a day or so beforehand. 

Otherwise, it is difficult for you. 

Mr. SHIMKUS. Well, if you would yield, I know that we got one 

at 8:30 last night. 

OPENING STATEMENT OF HON. FRANK PALLONE, JR., A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW JERSEY 

Mr. PALLONE. All right. Well, I apologize for that, and we are 

going to proceed. But what we will do, we will try to make sure 

that in the future that we get them further in advance. And I will 

find out what the official deadline is. But even regardless of the official deadline, I think we should have them a couple days in advance. Otherwise, you can’t review them. So we will follow up on 

that. 

Today is Earth Day, obviously a very important day intended to 

inspire awareness of and appreciation for the earth’s environment. 

It is a day when we call on everyone to do a little something for 

the planet. It could be as simple as picking up litter or something 

more long-term, like planting a tree. And this is the 40th Earth 

Day, and I reflect not only on the environment but also on the 

nexus between the environment and human health. It is important 

to recognize that what we do to our planet can have a direct impact 

on our health. Initiatives to cleanse our waterways, protect our forests, clean up toxic waste sites not only have a positive environmental effect but they also benefit the health of all Americans. And 

because of this, the Subcommittee has convened today to discuss 

the work our federal health agencies are doing with respect to environmental health. Within HHS there are four main bodies that address environmental health issues, the National Institute of Environmental Health Sciences, the National Toxicology Program, the 

Centers for Disease Control and the Agency for Toxic Substances 

and Disease Registry. They are all here today to provide the committee with an overview of their efforts. 

Environmental health is defined by the World Health Organization as the aspects of the human body, human health and disease 

that are determined by factors in the environment, and this includes conditions like neurological diseases, cancers and 

cardiopulmonary diseases that can be caused by events ranging 

from lead in the drinking water to air pollution. And I know there 

are some challenges when it comes to linking environmental hazards with public health events, and I hope to learn more about 

those challenges today and perhaps even what we might be able to 

do about it. 

A few years back I was made aware of a high incidence of cancer 

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has more Superfund sites than any other state. And fearing a connection, the New Jersey Department of Health and Senior Services 

conducted an investigation into the issue. At the time, the agency 

found no statistical proof that the rates of cancer were higher in 

this particular neighborhood than in other areas of the State and 

could also not make a determination that the diseases were linked 

to the Superfund sites. So I understand that there are often data 

challenges when it comes to linking environmental events to public 

health, and I am eager to hear more about these and similar challenges today at this hearing. 

Questions such as how do the agencies look at the relationship 

between toxic sites and disease outbreaks and what are the barriers to making those determinations, these are the kinds of questions hopefully we can get some answers to. 

I am also eager to hear about the research that is currently being 

conducted on environmental health conditions. I have a facility in 

my district that has done a lot of work on this issue. The Center 

for Environmental Exposures and Disease run by UMD&J, the 

Robert Wood Johnson School of Medicine and Rutgers University 

is one of the grant recipients from NIEHS and is doing very exciting work on research, environmental health education and disease 

prevention, and I am curious to hear from the NIEHS about their 

priorities for the next few years and how you balance national priorities with research questions that might be more State-specific. 

And finally I am very interested in hearing more about how all 

three agencies work together to try and advance the field of environmental health. 

Again, welcome our witnesses. I know that you are doing a lot 

of very exciting work. Sometimes it may sound bureaucratic, but I 

want to tell you, when it comes to my state and my district, the 

work you do—you are called upon constantly. I know I call you on 

a regular basis to come to New Jersey to check out some of these 

links between toxic waste and health, which you know, is a major 

concern and should be a major concern for my constituents and I 

think all Americans. 

I yield to our Ranking Member, Mr. Shimkus, of Illinois. 

OPENING STATEMENT OF HON. JOHN SHIMKUS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF ILLINOIS 

Mr. SHIMKUS. Thank you, Chairman Pallone. I appreciate this 

Subcommittee and remain active, but I currently continue to be 

disappointed that we aren’t holding hearings on the implementation of the new health reform law. 

In my district, people aren’t asking about if a healthy earth 

means healthier humans or if smokeless tobacco is bad for children. 

We know it is. People are asking questions on what we have read 

and being reported on the changes that will come now and in the 

future with the new health reform law. So why aren’t we doing follow up? Was there a drafting error so children with preexisting 

conditions are not going to be receiving coverage immediately if 

possible? Is it true those currently in high-risk insurance pools will 

be stuck paying higher premiums because they don’t qualify for the 

new high-risk pools? Do they really need to be uninsured for 6 

months to receive this coverage? If families with low wages are 


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dumped into Medicaid because their employer opted to pay for coverage through the state exchanges, will they have access to the 

same coverage as those in the exchange? Can they see the same 

doctors? These are all questions that people are asking and questions that are being reported in the media. How about this one, for 

those in the individual market, are their premiums going to rise on 

average of $2,100 as stated by the CBO and reported in a recent 

New York Times article? 

The health reform law says penalties will occur if you don’t have 

insurance coverage for at least 3 months in the year. Can someone 

cancel their coverage after 3 months and 1 day and then wait until 

they get sick to repurchase coverage? Will that mean increases in 

insurance premiums for those who play fair? Are small businesses 

going to be able to afford to provide health insurance? Is just 12 

percent of the small business population going to benefit in any 

way from the tax credits as reported by the CBO? Is it true that 

firms with more than 25 employees will get no tax credit at all? 

And for those few that qualify, if the credit is only available for 6 

years, how do they afford healthcare costs beyond them in the future years? 

These are the questions my constituents are asking and questions we as members of the Health Subcommittee should be addressing because some of these problems we can fix now. We can 

pass a bill and rectify some of these problems we already know 

that exist on this healthcare bill. 

We were supposed to have Caterpillar, AT&T and others in front 

of the O&I Subcommittee to discuss their financial disclosures and 

burdens. Last week that hearing was quietly cancelled. Then next 

week this Subcommittee was going to address Medicare and Medicaid fraud. That has now been postponed. 

Chairman Pallone, I really do want to work with you on evaluating those provisions that we know are bad in this bill that we 

can fix. I know we are going to have numerous hearings on 

healthcare issues. I am here to represent my constituents of the 

19th district in Illinois, and there is a high level of fear out there 

of the unknown, and I think our committee could do well in getting 

some of these questions answered. 

And with that—— 

Mr. BUYER. Will the gentleman yield? 

Mr. SHIMKUS. I would yield. 

Mr. BUYER. When you mentioned that the O&I Subcommittee 

was cancelled, was that cancelled—part of that hearing, was it because these corporations are out there, they were talking about 

what they were going to have to mark down because of their cost 

in the accounting practices and they were going to challenge them. 

As it has turned out, what the companies were saying was absolutely true. Under the accounting practices, they are required as a 

public company to disclose as soon as they learn what their liability 

is, they must mark that down in that quarter. And so all of these 

publically traded companies who quickly did an assessment of what 

the cost would be, billions of dollars now are being marked down 

against earnings in this quarter. Is that not correct? 

Mr. SHIMKUS. That is correct. A lot of these were announced 

after the passage of the bill. I used actually one of these companies 


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which was Caterpillar on the floor prior to the vote to talk about 

the cost that would incur. And I think the goal was to bring these 

CEO captains of industry in here and embarrass them, and I think 

what is the truth is, they were just following the SEC code. 

Mr. BUYER. Would the gentleman further yield? 

Mr. SHIMKUS. I would. 

Mr. BUYER. I notice this week Eli Lilly, which is a very strong 

corporate partner even in Indiana had to mark down their earnings 

around 11 or 12 cents and companies all over the country. So when 

they talked about the cost of this healthcare bill to carry that burden, in fact, it is true. It was a reality. So instead of facing the embarrassment, the Democrat majority cancelled that. Is that not correct? 

Mr. SHIMKUS. Well, you would have to talk to Chairman Waxman as far as his intent, but I do know that it was scheduled and 

it was cancelled. 

Mr. BUYER. Thank you. 

Mr. SHIMKUS. And I yield back my time. Thank you, Mr. Chairman. 

Mr. PALLONE. Thank you. Next is the gentlewoman from California, Ms. Harman. 

Ms. HARMAN. Mr. Chairman, I have agreed to let Dr. 

Christensen go ahead of me. 

Mr. PALLONE. OK. The gentlewoman from the Virgin Islands. 

OPENING STATEMENT OF HON. DONNA M. CHRISTENSEN, A 

REPRESENTATIVE IN CONGRESS FROM THE VIRGIN ISLANDS 

Mrs. CHRISTENSEN. Thank you, Mr. Chairman, and thank you 

Chairman Pallone and Ranking Member Shimkus for holding this 

important hearing, and it is very appropriate that we are having 

it on Earth Day. And thank you, Dr. Birnbaum and Dr. Falk for 

joining our witness panel this morning. 

As chair of the Health Braintrust of the Congressional Black 

Caucus which has as its mission the elimination of health disparities, I have joined now with Jim Clyburn and his Environmental 

Justice Braintrust over the years on joint conferences around the 

country to increase the awareness especially in poor, rural communities and communities of color on a nexus between environment 

and human health. In fact, earlier this week I spent a day-and-ahalf on environmental justice tour in South Carolina. 

Research has shown us that numerous environmental factors 

from biochemical hazards and water contamination to unhealthy 

land uses are among the factors that not only drive and sustain but 

exacerbate racial and ethnic health disparities. For example, environmental factors are directly linked as causal factors to some of 

the worst health disparity trends such as childhood asthma, cancer, 

incidents of mortality that we see in this Nation today. And it 

should come as no surprise. A 2006 study revealed that racial and 

ethnic minorities and poor individuals are disproportionately more 

likely than whites and middle- to upper-income individuals to live 

near toxic waste facilities. The U.S. Department of Health and 

Human Services has long recognized the inextricable link between 

the environment and human health and has numerous agencies 

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issues. I have worked with these agencies and offices in communities in my district, but in the last Administration changes were 

made and we lost a lot in follow-through. My community and I 

would imagine other communities were not as well served as before. 

So I look forward to this hearing with the National Center for 

Environmental Health, ATSVR, and the National Institute for Environmental Health Sciences and any other offices, where they 

stand today, how we work with EPA and other relevant agencies 

and how from assessments to services to research we are improving 

the health of people and communities by improving the environments in which too many of them are struggling against the odds 

to be well. 

I yield back my time. 

Mr. PALLONE. We thank the gentlewoman. Next is the gentleman 

from Indiana, Mr. Buyer? 

Mr. BUYER. I will defer and take the time later. 

Mr. PALLONE. Take the 8 minutes? OK. Thanks. Gentlewoman 

from Tennessee? Oh, I guess I am supposed to go back to the 

Democratic side. Gentlewoman from California, Ms. Harman. 

OPENING STATEMENT OF HON. JANE HARMAN, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF CALIFORNIA 

Ms. HARMAN. Thank you, Mr. Chairman, for holding this hearing. Welcome to our witnesses, and happy Earth Day. The 40th anniversary of Earth Day should cause us, as you said, to celebrate 

the strides we have made in environmental protection and education and to focus on the road ahead. 

The earth has a long memory, and one of the results of years of 

profligate polluting are the hazardous waste dumps now designated 

Superfund sites. The residents of my Congressional district in 

Southern California have seen first hand the adverse effects such 

sites create and understand the very real risks to human health. 

We have been trying to clean up three Superfund sites that border 

my district and have affected our residents, particularly minority 

communities, as Dr. Christensen pointed out, for decades. They are 

called Del Amo, Montrose, and the Palace Verde Shelf. The Del 

Amo and Montrose facilities released substantial amounts of hazardous substances into the soil and groundwater including benzene 

and DDT. Montrose also dumped DDT through the sewer system 

into the Pacific Ocean, and this along with PCBs from other industrial sources created the Palace Verde Shelf problem that threatens 

marine life and human health through contaminated fish consumption. The Montrose site has been paved with temporary asphalt cap 

to protect workers and to prevent the spread of contaminated soils. 

Groundwater and soil cleanup plans are in progress. 

The Del Amo site, which I know very well, has mostly been redeveloped into an industrial park. The most contaminated section, 

the waste pits, have been fenced off in a so-called containment zone 

to prevent further spread into drinking water sources. Because 

hazardous materials from Del Amo and Montrose are comingled, 

these sites will be part of the same groundwater remediation effort, 

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The Palace Verde Shelf cleanup effort is also in progress, and a 

coalition of local groups have done good work in reaching out to 

vulnerable communities to educate them about avoiding contaminated fish consumption. However, restoring the area to what it 

once was remains a monumental task, and EPA still considers the 

site to be one of the most contaminated in the country. 

I would like our witnesses to address their familiarity with these 

sites and whether they have studied their effects and more broadly 

hope that they will address what HHS is doing to inform the pubic 

about the potential adverse health effects. 

Thank you, Mr. Chairman, for holding this hearing. There is a 

lot to celebrate and to be sober about on Earth Day, and I yield 

back. 

Mr. PALLONE. Thank you. Gentlewoman from Tennessee, Ms. 

Blackburn? 

OPENING STATEMENT OF HON. MARSHA BLACKBURN, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF TENNESSEE 

Mrs. BLACKBURN. Thank you, Mr. Chairman, and welcome to our 

witnesses. 

I will have to say that I am surprised again that this committee 

is holding a general hearing, this time on environmental health 

issues that, while they are important, they are not the pressing 

needs of the day. The link between environmental factors and 

health is more clearly illuminated by common sense, not Congressional oversight. 

Is it lost on anybody in this room that the recent healthcare bill 

signed into law is destined to restrict access, drive up costs and has 

so many unknown consequences that we are only starting to uncover the little gems that are hidden in the bill? I know my staff 

would appreciate sunshine on the status of their health insurance 

benefits and whether or not they are on the right side of the law 

because this law was so poorly written. The healthcare law has potentially left Members of Congress and their staff without health 

insurance. It is disappointing that OPM had to rule on this to validate our insurance as opposed to the law stating the intent explicitly. 

I would also appreciate hearing from the drafters of that fine 

piece of legislation as to why they and all other federal employees 

were exempted. What is good for one should be good for all. I think 

we can agree to that. 

The press continues to report the promises of lower health insurance premiums and the healthcare overhaul may not be. They may 

not take place. So could it be that the bill won’t lower cost of insurance and increase access? Certainly there is no public option model 

that has done that, and you can look at TennCare in Tennessee 

and Massachusetts Universal Healthcare Plan to prove that point. 

I would also like to hear from our governors about the unfunded 

mandates on their states and how they are going to address the 

cost of that implementation. And what about the seniors who were 

told that if they liked their health coverage, they could keep it? We 

are going to have a lot of angry constituents this October when 

they learn that their Medicare Advantage plan is dwindling and 


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that they will have to pick up the tab for drugs and medical devices 

indirectly due to new taxes that are placed on such items. 

Mr. Chairman, many pressing issues exist in healthcare today. 

This committee and the Nation would be better served focusing on 

new healthcare mandates rather than today’s Earth Day hearing. 

I yield back. 

Mr. PALLONE. Thank you. Chairman Dingell? 

Mr. DINGELL. Thank you, Mr. Chairman. I want to commend you 

for holding this hearing. I do want to pause just briefly to observe. 

I am afraid the distinguished gentlewoman who just preceded me— 

or I have walked into the wrong hearing? I was under the impression that this was a hearing which related to the important matters of the connection between environmental factors and human 

health. If I am in error that I am in the wrong room here, I hope 

that somebody will please inform me. 

Mr. SHIMKUS. Will the gentleman yield? 

Mr. DINGELL. I will be happy to yield if—— 

Mr. SHIMKUS. You can tell by the audience that this is health 

and the environment, not the healthcare bill. Otherwise, we would 

have had a line outside stretching overnight. The issue is we have 

identified problems with the healthcare bill that need to be 

fixed—— 

Mr. DINGELL. Well—— 

Mr. SHIMKUS [continuing]. And we ought to be addressing those 

versus talking about—— 

OPENING STATEMENT OF HON. JOHN D. DINGELL, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF MICHIGAN 

Mr. DINGELL. I want to thank the gentleman, and I want to tell 

him how much I appreciate his attempt to assist me. I do observe, 

however, that he is shedding more confusion upon me this morning, and it is rather early for me to undergo this kind of confusion. 

But having said that, Mr. Chairman, I want to continue by commending you for holding this hearing. It is important for us as a 

society to have better understanding of the connection between environmental factors and human health. Thirty-five years ago the 

United States had virtually no laws in place to protect the environment and human health. Private individuals, industry, governments could burn, dump or pump into the air or water or into the 

ground virtually anything with impunity and without concern as to 

the consequences to all of us or to the environment. 

Some of my proudest achievements during my service in Congress, apart from our legislative health victories which I am happy 

to see our Republican colleagues are noting, have been the part 

that I played in writing environmental protection statutes which 

were of great and landmark importance to our country. These laws 

weren’t just victories just for the environment but they were victories for our health and well-being as a Nation. Therefore, it is fitting that today, on Earth Day, we hear from the Department of 

Health and Human Services about their role in identifying and preventing health problems caused by our environment. Our society 

has made enormous strides because of research in this area. We 

now know of the dangers caused from contact with asbestos, and 


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we now know that the elevated exposure to lead and mercury can 

create development problems for children. We also know that air 

pollution can aggravate asthma. This research has allowed us to 

take the appropriate legislative and societal actions to reduce illnesses caused by these toxins and others. Yet, there is still much 

more that we need to know and to learn in order to prevent avoidable illness and death due to environmental factors. According to 

the World Health Organization, 13 million deaths occur annually 

from preventable environmental causes. 

I want to thank our panel today, Dr. Linda Birnbaum with the 

National Institute of Environmental Health Sciences and the National Toxicology Program and Dr. Henry Falk with the National 

Center for Environmental Health and Agency for Toxic Substances 

and Disease Registry today. Too often we unfortunately only discuss these issues in response to some tragic event, an oil spill or 

toxic waste leak or something else that jeopardizes life or well 

being of our people. It is my hope that today’s hearing will lead to 

a discussion about how the government can continue to proactively 

lead in research and programming that improves health and well 

being of the Nation through promotion of a healthy and safer environment. 

And again, I do want to welcome our witnesses, and I hope that 

they are not confused as I have been about the purposes of this 

hearing. So with that, Mr. Chairman, I thank you and yield back 

the balance of my time. 

Mr. PALLONE. Thank you Chairman Dingell. I saw two young 

girls walk in here, and I was reminded that today is Take Your 

Daughter to Work Day. So good to see you here, and I hope it is 

interesting for you. 

Next is the gentleman from Texas, Mr. Burgess. 

Mr. BURGESS. Thank you, Mr. Chairman. I am so anxious to get 

to the testimony of our witnesses I will waive an opening statement. 

Mr. PALLONE. Thank the gentleman. He will have the extra time 

on questions. 

Next is the gentleman from Georgia, Mr. Barrow. 

Mr. BARROW. I thank the Chair. I cannot possibly improve upon 

the opening of the Chairman Emeritus, so I too will waive an opening. 

Mr. PALLONE. Thank you. Gentlewoman from Florida, Ms. Castor? 

OPENING STATEMENT OF HON. KATHY CASTOR, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF FLORIDA 

Ms. CASTOR. Yes. Thank you, Chairman Pallone very much for 

calling this hearing today, and welcome to the witnesses. 

I am eager to hear you because nothing is more fundamental to 

families all across America than clean water and clean air, and it 

is vitally important that we understand the link between environmental factors and the health of our families. So I look forward to 

hearing what the agencies under HHS have to offer in protection 

and research and guidance, and this is critical. And we need more 

research. As you know, the EPA has tested approximately 200 of 

the more than 80,000 chemicals that have been on the market 


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since the Federal Government began to regulate toxic substances 

33 years ago. Of those tested, only five are now regulated. So we 

are dealing at the same time with an update to our outdated 

TOSCA law. The potential links between chemicals and environmental factors and the Nation’s leading chronic illnesses sometimes 

remain a mystery, and they shouldn’t. It is clear that rates of asthma, certain cancers, diabetes, premature births, heart disease and 

others have increased as the chemical industry has grown. In my 

community, in the Tampa Bay area in Florida, my neighbors have 

seen first hand over the years how the presence of toxic chemicals 

and environmental contaminants can tear apart communities and 

make people very sick and drastically lower property values. 

For example, in 2004 in Plant City, which is on the outskirts of 

Tampa, residents living in the vicinity of a plant began to notice 

strange cases of cancer, a real cluster, and gastroenterological 

issues in the community. After investigation, officials found levels 

exceeding state and federal standards of arsenic, boron, radium, 

lead and cadmium. The Florida Department of Environmental Protection linked the pollution from the plant to at least seven contaminated wells used for drinking water. After the contamination 

was discovered, the state had to begin providing bottled water for 

families living in the area. 

Families that lived in the area for years believed that the contaminants led to long-term health problems that weren’t realized 

until they left the area, such as fertility problems for women who 

had lived near the plant as young girls. 

Also across the way in 2008, a factory in St. Petersburg was determined to be responsible for a plume of toxic chemicals that migrated to an elementary school and contaminated the ground water 

there. This time, last year after the pollution problem had been ongoing for 17 years, the factory submitted a plan to the Florida Department of Environmental Protection to finally clean up the contaminants around this facility. 

Experts find that areas nationwide which are affected by contamination of rare chemicals are largely communities of color and 

low-income communities unfortunately. You still have to deal in 

America with the issues of environmental justice. So I hope you 

will shed some light on that today. 

There are disproportionately high levels of exposure to toxic 

chemicals in these areas, and folks in these neighborhoods are getting sick at extraordinarily high rates. So communities and families need talented researchers like you and the folks that you work 

with to ensure that the air we breathe and the water we drink is 

safe, is not detrimental to our health. 

So again, thank you, Mr. Chairman, for convening this hearing, 

and thank you to Dr. Birnbaum and Dr. Falk for being here today. 

This is certainly a topic that we need to continue to learn more 

about. 

Mr. PALLONE. Thank you. The gentleman from Georgia, Mr. 

Gingrey. 


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OPENING STATEMENT OF HON. PHIL GINGREY, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF GEORGIA 

Mr. GINGREY. Mr. Chairman, thank you for holding this hearing 

today on the potential impact that environmental factors can have 

on the health of American patients. 

For over 30 years I practiced healthcare with a focus on OB/ 

GYN. During those years, I saw firsthand the impact that infertility can have on patients and their loved ones. Data from the 

CDC’s National Survey of Family Growth estimated in 2002 that 

7.3 million American women aged 15 to 44 had experienced difficulties conceiving or bringing a pregnancy to term during their lifetime, and additionally 2 million couples in the United States were 

listed as infertile, that is, not having successfully conceived during 

the previous 12 months. Although the focus of research and services in this country has traditionally been on women, fertility impairments may be just as common, they certainly are quite common, among men. 

To be frank, some of these cases are preventable. The Surgeon 

General’s report on the health consequences of smoking, for instances, highlights numerous adverse reproductive effects of tobacco smoking, including infertility. In women, tobacco smoking is 

associated with a decreased probability of conception, ovulatory 

dysfunction and early menopause. However, these do not alone explain the reasons or solutions for infertility in this country, and 

therefore, I look forward to exploring these issues with the witnesses and with the committee. 

Additionally as an issue that is near and dear to my heart is our 

nation’s infant mortality rate and how our country compares to others. Today we do not have a good understanding of how our numbers compare to other countries, so that data is not very consistent 

from state to state and region to region. A better understanding of 

infant mortality numbers in our country might give us a better insight into some of its causes, be they environmental factors or any 

other contributing issue. Everything from the products that we ingest, the conditions in and around our environment, and the medical procedures or treatments that we subscribe to can have an impact on the mortality rates of our infants. I believe that a consistent understanding of our own mortality rates here in the 

United States can give us a better understanding of how we compare internationally. We had that debate on the healthcare bill. 

And if such comparisons were possible, we as a Nation might learn 

a lot more about the contributing causes of infant mortality and 

better ensure that parents have the information they need to raise 

a happy and a healthy child. 

So with these thoughts in mind, Mr. Chairman, as I yield back, 

I look forward to hearing from our witnesses. Thank you. 

Mr. PALLONE. Thank you. The gentleman from Pennsylvania, Mr. 

Pitts? Will waive? OK. I think all of our members have had a 

chance to do an opening statement, so we will move onto our panel 

and our witnesses. And I want to welcome both of you today. The 

way we work it, and you probably know, is we have 5-minute opening statements and they are made part of the record, but you may 

in the discretion of the committee, submit additional statements, 

brief statements, in writing for inclusion in the record. 


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Let me introduce each of you. To my left is Dr. Linda Birnbaum 

who is Director of the National Institute of Environmental Health 

Sciences and the National Toxicology Program. Welcome. And then 

there is Dr. Henry Falk who is Acting Director for the National 

Center for Environmental Health and the Agency for Toxic Substances and Disease Registry. 

I have to tell you that the ATSDR is a big deal in New Jersey. 

I often mention it, and it used to be years ago that people would 

say, well, what is that? But nobody says that anymore because you 

are always around, so we appreciate it. 

We will start with Dr. Birnbaum. 

STATEMENTS OF LINDA BIRNBAUM, DIRECTOR, NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES AND NATIONAL TOXICOLOGY PROGRAM, AND HENRY FALK, ACTING 

DIRECTOR, NATIONAL CENTER FOR ENVIRONMENTAL 

HEALTH AND AGENCY FOR TOXIC SUBSTANCES AND DISEASE REGISTRY 

STATEMENT OF LINDA BIRNBAUM 

Ms. BIRNBAUM. Mr. Chairman and distinguished members of the 

Subcommittee, I am pleased to appear before you on the 40th anniversary of Earth Day to present testimony on the role of NIEHS 

in understanding the impact of environmental exposures on human 

health. My name is Linda Birnbaum, and I am the Director of 

NIEHS which is part of the National Institutes of Health, as well 

as Director of the National Toxicology Program, which is a crossagency program involving NIH, CDC and FDA. 

NIEHS supports the full range of basic biology to human epidemiology to chemical testing. Our research goes from bench to bedside to public health. It provides information for policymakers who 

are responsible for decisions affecting public health and for the 

public who deserve to have the best information on how to prevent 

disease and dysfunction. We work closely with other federal agencies, especially CDC, FDA, EPA, OSHA and the Consumer Product 

Safety Commission and with impacted communities throughout our 

community-based research programs and outreach efforts required 

for environmental health, Superfund and children’s grants. We collaborate with other NIH institutes on asthma intervention, cancer 

and autism studies. 

Environmental health science is advancing at a tremendous rate. 

Our understanding of chemical toxicity has been challenged by the 

new science of epigenetics, which is the study of changes in the 

packaging of DNA that influence how genes are expressed. Studies 

indicate that exposures that cause epigenetic changes can affect 

several generations. This new understanding heightens the need to 

protect people at critical times in their development when they are 

most vulnerable. 

Related to the field of epigenetics is the key concept of windows 

of susceptibility. Research shows that the developmental processes 

that occur at fetal and early-life stages are especially vulnerable to 

disruption from relatively low doses of certain chemicals. We first 

saw this in the case of lead which we learned decades ago could 

harm neurological development as the result of early-life exposure. 


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This concept also applies to hormonally active agents that disrupt 

the endocrine system. For example, NIEHS and NTP are funding 

important studies to fill the gaps in our knowledge about biphenyl 

A, a widely distributed, high production compound with many uses, 

including plastics, food can linings, thermal paper and much more. 

The NTP determined that there was some concern about effects to 

the brain and reproductive system in fetuses, infants, and children 

exposed to BPA. We are now supporting an aggressive research effort to fill the research gaps in this area, especially concerning BPA 

effects on behavior, obesity, diabetes, reproductive disorders, development of prostate, breast and uterine cancer, asthma, cardiovascular disease and transgenerational or epigenetic effects. 

In our NIEHS Breast Cancer and Environment Research Program, co-funded with the NCI, researchers are investigating whether periods of susceptibility exist in the development of the mammary gland, when exposure to environmental agents may impact 

the breast and endocrine system that can influence breast cancer 

risk in adulthood. 

The joint NIEHS/EPA program of 14 Centers for Children’s Environmental Health is expanding into new areas of research including birth defects, childhood cancer including leukemia, diabetes, 

pubertal development and the developmental basis of adult disease. 

Environmental exposures are being implicated in the obesity epidemic. NIEHS is supporting research on the developmental origins 

of obesity and the theory that environmental exposures during development play an important role in the current epidemic of obesity, and metabolic syndrome and diabetes. Thus, we need to start 

thinking about obesity not just in terms of genetics and lifestyle 

but also in terms of how early life exposure to these obesogenic 

chemicals might be setting the stage for us to gain weight later in 

life. 

Through our Superfund research program, we support research 

on state and transport of toxic substances and the environment, on 

new technologies to clean up hazardous waste and on the health 

effects of Superfund chemicals. This is a problem-solving program 

that provides information and new technologies to help ATSDR and 

EPA and the impacted communities do better risk assessments and 

clean-ups. 

The NIEHS Superfund program features many examples of excellent environmental health research with real-world impact. For 

example, our Superfund grant to New York University includes an 

outreach program in New Jersey with a major goal of building a 

partnership between researchers and chromium impacted community members in Hudson County, the majority of whom are Hispanic or African American. Such a partnership provides a path by 

which our Superfund researchers can reach communities that are 

concerned about possible chromium exposure. It is a full partnership in which the community participates in the project from its design through its conclusion. 

With our rapidly increasing understanding of the subtleties of biological effects of environmental exposures, we can move forward 

into an era of a new kind of toxicological testing that is less expensive and time-consuming than our current methods and also gives 

us an improved understanding of the actual effects on humans. The 


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NTP is laying the foundation for this testing paradigm in partnership with the National Human Genome Research Institute, EPA, 

soon to be joined by FDA. We are using quantitative high-throughput screening assays to test thousands of chemicals. The resulting 

data are being deposited into publicly accessible databases. Analyses of these results will set the stage for a new framework of toxicity testing. 

In summary, understanding the connection between our health 

and our environment, with its mixture of chemicals, diet and lifestyle stressors, is no less complex than understanding the intricacies of the human genome. At NIEHS, we remain committed to 

leading the evolution of the field of environmental health sciences 

to meet emerging public health challenges. 

Mr. Chairman and members of the Subcommittee, in celebration 

of Earth Day, I thank you for giving me the opportunity to present 

testimony on NIEHS’ important research activities, and I would be 

happy to answer any questions. 

[The prepared statement of Ms. Birnbaum follows:] 


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Testimony 

Subcommittee on Health 

Committee on Energy and Commerce 

United States House of Representatives 

The Environment and Human Health: 

The Role of HHS 

Statement of 

Linda Birnbaum, Ph.D., D.A.B.T., A.T.S. 

Director, National Institute of Environmental Health 

Sciences, National Institutes of Health, and 

Director, National Toxicology Program 

U.S. Department of Health and Human Services 

For Release on Delivery 

Expected at 9:30 a.m. 

April 22, 2010 
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Mr. Chairman and distinguished members of the Subcommittee-I am pleased to appear before 

you today to present testimony on our current understanding of and research activities on 

environmental health. My name is Linda Birnbaum; I am the Director of the National Institute 

of Environmental Health Sciences (NIEHS) of the National Institutes of Health, as well as the 

National Toxicology Program (NTP). 

Environmental health science is advancing at a tremendous rate. We are bringing all the new 

tools of biomedical science to bear on the fundamental questions ofthe effects of toxic 

substances on biological systems. These tools genetics, genomics, proteomics, metabolomics, 

informatics, computational biology, just to name some of these new disciplines - give us new 

insights on how environmental effects happen in our bodies, but also technologies to improve 

testing procedures to provide better and more timely information for the use of our agency 

partners who are responsible for risk assessment and risk management. 

Our understanding of chemical toxicity has been challenged by the new science of epigenetics, 

which is the study of changes to the packaging of the DNA molecules that influence the 

expression of genes, and hence the risks of diseases and altered development. Studies indicate 

that exposures that cause epigenetic changes can affect several generations. 1 This new 

understanding heightens the need to protect people at critical times in their development when 

they are most vulnerable. 

J Anway MD, Cupp AS, Uzumcu M, Skinner MK (2005) Epigenetic transgenerational actions of endocrine 

disruptors and male fertility. Science 308:1466-1469 

2 
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Related to the field of epigenetics is the key concept of "windows of susceptibility." Research in 

animals and humans shows that the developmental processes that occur at fetal and early life 

stages are especially vulnerable (0 disruption from relatively low doses of certain chemicals. 234 

We first saw this in the case of lead and other metals, which we leamed decades ago could harm 

neurologieal development as a result offetal and childhood exposures. This concept also applies 

to hormonally active agents which disrupt the endocrine system. This is an active area of our 

research program. For example, NIEI'lS and NTP are funding important studies to fill the gaps 

in our knowledge about bisphenol A (BPA), a widely distributed, high production compound 

with many uses, including plastics, food can linings, bottle tops, water supply pipes, and thermal 

paper recycling. Our Center for Evaluation of Risks to Human Reproduction determined that 

therc was "some coneem" about effects to the brain, behavior and prostate gland in fetuses, 

infants, and children exposed to BPA. 5 We are now supporting an aggressive research effort to 

fill the research gaps in this area, especially concerning BPA effects on behavior, obesity, 

diabetes, reproductive disorders, development of prostate, breast and uterine cancer, asthma, 

cardiovascular diseases and transgenerational or epigenetic effects. 

In our NIEHS Breast Cancer and Environment Research Program, co-funded with the National 

Cancer Institute, researchers are investigating whether windows of susceptibility exist in the 

development of the mammary gland, when exposures to environmental agents may impact the 

breast and endocrine systems that can influence breast cancer risk in adulthood. 

2 Rogan WR, Ragan NB (2003) Evidence of effects of environmental chemicals on the endocrine system in children. 

Pediatrics 112:247-252 

3 Dolinoy DC, Weidman JR, Jirtle RL (2007) Epigenetic gene regulation: Linking early developmental environment 

to adult disease. Reproductive Toxicology 23:297-307 

4 Committee on Environmental Health, American Academy of Pediatrics (1999) Pediatric environmental health, 20d 

edition, pp 9-23 

5 http://www.niehs.nih.gov/news/mcdiaiquestiol1s/sya-bpa.cfm Sec "What does some concern mean?" 

3 
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The joint NIEHS/EPA program of 14 Centers for Children's Environmental Health is expanding 

into new areas of research including birth defects, childhood cancer including leukemia, 

diabetes, pubertal development, and the developmental basis of adult disease. This research is 

directed towards additional children's environmental health issues such as epigenetics, 

transgenerational effects, diet, oxidative stress, and tissue sensitivity. The Children's Center 

program continues its mentoring and support of new investigators and also actively supports the 

engagement of new community groups involved in children's environmental health issues. 

Environmental exposures are now also being implicated in the obesity epidemic67 • NIEHS is 

supporting research on the developmental origins of obesity and the theory that environmental 

exposures during development play an important role in the current epidemic of obesity, 

diabetes, and metabolic syndrome. There are data showing weight gain in adult rats and mice 

following developmental exposure to a number of different chemicals,8 which have been termed 

"obesogens" by some researchers. Thus, at NIEHS we find it may be useful to start thinking 

about obesity not just in terms of genetics and lifestyle, but also in terms of how early life 

exposure to these "obesogenic" chemicals might be setting the stage for us to gain weight later 

in life. 

6 Grun F, Blumberg B (2009) Endocrine disrupters as obesogens. Mol Cell Endocrinol 304: 19-29 

7 Verhulst SL, Nelen V, Hand ED, Koppen G, Beunckens C, Vael C, Schoeters G, Desager K (2009) Intrauterine 

exposure to environmental pollutants and body mass index during the first 3 years of life. Environ Health Perspect 

1I7:122·126. 

g Iguchi T, Watanabe H, Ohta Y, Blumberg B (2008) Developmental effects: oestrogen-induced vaginal changes 

and organotin-induced adipogenesis. Int J AndroI31:263-268. 

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NIEHS is also helping lead the way to developing new environmental monitoring technologies. 

Determining actual levels of exposure for use in research, risk assessment, and risk management 

is an ongoing challenge, and NIEHS is actively pursuing many research approaches to help solve 

this problem and thus promote more accurate science and better decision making. For example, 

the NIEHS is supporting development and testing of a robot called PIPER9 capable of 

mimicking children'S floor activities while collecting better estimates of young children's 

exposure to indoor air pollutants (particulate matter, pesticides, allergens, endotoxins and 

airborne fungi). A study of asthma and indoor environmental contaminants is currently 

underway to test PIPER in the homes of200 children. The study will compare measurements of 

particulates obtained by PIPER with those from standard adult height monitoring stations and 

examine their association with asthma symptoms. 

At NIEHS we also recognize that the ultimate goal is to move our science into real-world 

applications to solve problems in communities. The NIEHS Superfund programs feature many 

examples of excellent environmental health research with real-world impact. lo Our Superfund 

grantee at Ncw York University (NYU) works for the mayor of Jersey City as a consultant on the 

city's chromium cleanup. In addition, he has provided assistance to a Merced, CA neighborhood 

on its cleanup of a chromium problem. Our NYU Superfund grant includes an outreach project 

in New Jersey with a major goal of building a partnership between NYU researchers and 

chromium impacted community members in Hudson County, the majority of which are Hispanic 

or African American. Such a partnership provides a pathway by which our Superfund 

researchers can reach communities that are concerned about possible chromium exposure. It is a 

9 Pretoddler Inhalable Particulate Environmental Robotic 

10 http://www.niehs.nih.gov/research/supported/srp/ 

5 
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full partnership where the community participates in the design of the project from its onset 

through its conclusion. 

Another Superfund study from a group from Harvard, working in a population of pregnant 

women with relatively low arsenic exposures in Tar Creek, OK, showed that arsenic was 

associated with impaired glucose tolerance during pregnancy and therefore may be associated 

with increased risk of gestational diabetes. I I Researchers from the Duke University Superfund 

group recently learned that exposure to fipronil, a new pesticide being introduced to replace 

organophosphates for both household and agricultural use, results in the same adverse effects on 

neurodevelopment as chlorpyrifos. They also showed that the metabolic alterations evoked by 

early-life exposure to compounds often classified as "developmental neurotoxicants" support the 

idea of the potential involvement of environmental contaminants in the dramatic increase in 

childhood obesity and diabetes. 1213 

With our rapidly increasing understanding of the subtleties of biological effects of environmental 

exposures, we are poised to move forward into an era of a new kind of toxicological testing that 

is less expensive and time-consuming than our current methods, and also gives us an improved 

understanding of the actual effects on humans. Toxicology is advancing from a mostly 

descriptive science using disease-specific models to a better predictive science focused upon a 

II Adrienne S. Ettinger, Ami R. Zota, Chitra J. Amarasiriwardena, Marianne R. Hopkins, Joel Schwartz, Howard 

Hu, and Robert O. Wright. 2009. Maternal Arsenic Exposure and Impaired Glucose Tolerance during Pregnancy. 

Environmental Health Perspectives 117(7): 1059-1064. 

12 Slotkin, Theodore A. and Fredric J. Seidler. 2009. Protein kinase C is a target for diverse developmental 

neurotoxicants: transcriptional responses to chlorpyrifos, diazinon, dieldrin and divalent nickel in PCI2 cells. Brain 

Research 1263:23-32. 

13 Slotkin, Theodore A., Bethany E. Bodwell, Edward D. Levin, and Fredric J. Seidler. 2008. Neonatal exposure to 

low doses of diazinon: long-term effects on neural cell development and acetylcholine systems. Environmental 

Health Perspectives lJ6(3):340-8. 

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broad inclusion of target-specific, mechanism-based, biological observations. This means using 

alternative assays targeting the key pathways, molecular events, or processes linked to disease or 

injury, and incorporating them into a research and testing framework. The NTP is laying the 

foundation for this testing paradigm in partnership with the National Human Genome Research 

Institute, EPA, and soon, FDA. They are using quantitative high-throughput screening assays to 

test a large number of chemicals. The resulting data are being deposited into publicly accessible 

relational databases. Analyses of these results will set the stage for a new framework for toxicity 

testing. 

In summary, understanding the connection between our health and our environment, with its 

mixture of chemicals, diet and lifestyle stressors, is no less complex than understanding the 

intricacies ofthe human genome. At NIEHS, we remain committed to leading the evolution of 

the field of environmental health sciences to meet emerging public health challenges. 

Mr. Chairman and members of the Subcommittee, thank you for giving me the opportunity to 

present testimony on this important issue. I would be happy to answer any questions. 

7 
22 

Mr. PALLONE. Thank you, Dr. Birnbaum. Dr. Falk. 

STATEMENT OF HENRY FALK 

Mr. FALK. Thank you. Good morning Chairman Pallone and 

Ranking Member Shimkus and members of the Subcommittee. My 

name is Henry Falk, and I am the Acting Director of the National 

Center for Environmental Health at the Centers for Disease Control in Atlanta, Georgia, and Centers for Disease Control and Prevention and the Agency for Toxic Substances and Disease Registry. 

I am pleased to appear before this committee on Earth Day to discuss CDC and ATSDR’s work in addressing environmental health 

issues. At CDC and ATSDR, Earth Day is not just a day. We try 

to practice that all through the year. In addition to whatever special events we have for Earth Day, we have an ongoing Sustainability Program and a Chief Sustainability Officer. In our Go 

Green, Get Healthy Program we try to link environment and 

health, Go Green, Get Healthy initiatives, and they promote transportation choices such as biking, walking, car-pooling, public transit, making environmentally conscious food choices, conserving natural resources, operations in waste management and exemplifying 

sustainability, constructing all of our new buildings and facilities. 

I am very proud to say that our new toxicology and office buildings 

have lead certification gold and silver at CDC. 

In my dual role with NCEH and ATSDR, I have the opportunity 

to lead a highly dedicated group of scientists and public health 

practitioners working to identify and protect from environmental 

exposures to hazardous substances and seeking to provide answers 

on a wide variety of other issues related to human health and the 

environment. 

ATSDR is the principal non-regulatory federal public health 

agency responsible for addressing health effects associated with 

toxic exposures. The mission is to serve the public through responsive public health actions to promote healthy and safe environments and prevent harmful exposures. We collaborate with other 

agencies such as EPA and NIEHS. We focus on human health effects issues, try to be of service to all of the communities as Superfund sites, and I may say that in a prior stint as assistant administrator at ATSDR in 1999–2003, visited a number of sites in New 

Jersey such as the Tom’s River site and actually with the prior 

Chairman of this Subcommittee, Congressman Bilirakis, spent a 

number of visits in Tarpon Springs, Florida, the Stauffer Chemical 

site with Congressman Bilirakis. 

The CDC’s National Center for Environmental Health supports 

state and local governments through programs focusing on healthy 

homes, specifically related to childhood lead poisoning, environmental tracking and asthma prevention. We are trying to provide 

state and local health professionals with training and tools necessary to deal with the broad range of housing-related issues, particularly through our CDC Childhood Lead Poisoning Prevention 

Program. I was a pediatrician in the Bronx being trained in a residency program during the first Earth Day in 1970. Eight percent 

of children during the 1970s had blood lead levels greater than 10. 

Now it is 0.6 percent. So I think we have demonstrated a lot of 


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progress during that time and hopefully continue to achieve that 

going forward. 

I want to mention also our Asthma Control Program which provides funds to state and local governments and territorial programs 

to conduct activities in support of asthma control. We work very 

closely with NIH, NIEHS, National Heart, Lung and Blood Institute, a combination of better treatment and better dealing with environmental factors together I think can really make a big difference with asthma. 

We have an extensive biomonitoring program and a toxicology 

laboratory directly measuring chemicals and metabolites in people’s 

blood and urine, and I think that is very helpful going forward to 

EPA and others. 

So through our work with the environment, we strive to leave a 

legacy for our children. Many programs have a particular focus on 

children including the Childhood Lead Poisoning Intervention Program, ATSDR’s site-specific work and childhood asthma interventions. I am a pediatrician by training, part of my personal commitment to improving the environmental health of our children. I have 

been actively involved in the past and more recently again with the 

President’s Task Force on Environmental Health Risks and Safety 

Risks to Children which will research and address key children’s 

environmental health and safety issues. 

Thank you for the opportunity to provide this testimony to highlight our work in environmental health. I look forward to answering any questions you may have. Thank you very much. 

[The prepared statement of Mr. Falk follows:] 


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Testimony 

Subcommittee on Health 

Committee on Energy and Commerce 

United States House of Representatives 

The Environment and Human Health: 

The Role of HHS 

Statement of 

Henry Falk, M.D., M.P.H. 

Acting Director 

Agency for Toxic Substances and Disease Registry 

and 

National Center for Environmental Health 

Centers for Disease Control and Prevention 

U.S. Department of Health and Human Services 

For Release on Delivery 

Expected at 9:30 a.m. 

April 22, 2010 
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Introduction 

Good morning Mr. Chairman and distinguished Members of the Subcommittee. On 

behalf of Dr. Thomas R. Frieden, Director of the Centers for Disease Control and 

Prevention (CDC) and Administrator of the Agency for Toxic Substances and Disease 

Registry (ATSDR), I would like to thank you for the opportunity to present this testimony. 

I am Dr. Henry Falk, Acting Director of ATSDR and CDC's National Center for 

Environmental Health (NCEH). I am particularly pleased to be here on Earth Day. As a 

physician, I've spent more than 30 years working to protect the public from 

environment-related hazards and diseases. 

These are indeed exciting times for those of us in environmental health. The 

Department of Health and Human Services (HHS) is involved in several presidential 

initiatives related to environmental health. 

HHS and the Environmental Protection Agency are joining with other federal 

departments and agencies to work towards reestablishing the President's Task Force 

on Environmental Health Risks and Safety Risks to Children, and with this group we will 

collaborate to address the most critical children's environmental health issues facing the 

Nation. HHS is also participating in the President's Task Force on Childhood Obesity. 

Through this Task Force, HHS is working with other federal departments and agencies 

to identify research priorities and opportunities to collaborate to address environmental 

factors that may contribute to childhood obesity. 

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In my dual role with NCEH and ATSDR, I have the opportunity to lead a highly 

dedicated group of scientists and public health practitioners working to serve the public 

through responsive public health actions to promote healthy and safe environments and 

prevent harmful exposures. 

Work at NCEH and ATSDR focuses on our unique relationship to the environment and 

the ways in which the environment impacts human health. This work supports 

laboratory research, epidemiologic studies, environmental public health tracking, 

environmental public health capacity building, community public health assessments, 

other health impact assessments, and protecting communities from exposures related 

to Superfund hazardous waste sites. Our sister agency at NIH, the National Institute of 

Environmental Health Sciences (NIEHS), conducts basic, applied, and clinical research 

on the health effects of environmental exposures. ATSDR in particular, but also NCEH, 

are service agencies that identify strategies to translate and apply research. This work 

translates into suggested interventions that reduce the burden and threat of disease 

related to the environment. My testimony will highlight some areas where CDC and 

ATSDR have notable work in this area. 

Protect the public's health from toxic substances from Superfund sites and other 

sources 

ATSDR is the principal non-regulatory federal public health agency responsible for 

assessing health effects associated with toxic exposures. The Agency's mission is to 

serve the public through responsive public health actions to promote healthy and safe 

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environments and prevent harmful exposures. ATSDR and its basic authorities were 

established by the Comprehensive Environmental Response, Compensation, and 

Liability Act (CERCLA) of 1980 (more commonly known as the Superfund law), as 

amended by the Superfund Amendments and Reauthorization Act (SARA) of 1986. 

ATSDR focuses specifically on the human health effects of exposure to harmful 

substances in the environment and collaborates with other federal agencies like EPA 

and NIEHS. Although ATSDR is not a regulatory agency, ATSDR is able to achieve 

substantial impact by providing technical expertise, training, and funding to state public 

health agencies and by making recommendations to other agencies and communities 

on how to reduce or prevent exposures to hazardous substances. 

Developing an understanding of the health effects associated with toxic exposures is 

challenging and takes a long time-from a need to analyze environmental samples over 

time, to reconstructing estimate of past exposures, to the long latency period of some 

diseases potentially related to exposures. For example, ATSDR has been examining 

health effects from exposure to amphibole asbestos in Libby, Montana since 1999. 

Since that time, ATSDR has worked closely with the community on a number of projects and 

activities, including a mortality review, a Tremolite Asbestos Registry, a health study of the 

effectiveness of using computed tomography scans in identifying related lung problems, and a 

recently announced five year initiative to examine the health effects of exposure to Libby 

amphibole asbestos. 

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A good example of ATSDR's work linking environmental exposure to disease using the 

latest technologies is our health study in Toms River, New Jersey. Working with the 

New Jersey Department of Health and Senior Services (NJDHSS), ATSDR confirmed 

that the overall childhood cancer incidence rate in Dover Township was statistically 

significantly elevated for the period of 1979 through 1995. i This increased rate was 

primarily related to excesses of leukemia and brain/central nervous system cancer in 

females residing in the Toms River section of Dover Township. ATSDR conducted 

sophisticated modeling of the water distribution system that mapped the percentage of 

water that each household received from each well field on a monthly basis. An 

association was found between prenatal exposures to a particular well field between 

1982 and 1996 and leukemia in female children of all ages. At only a very few other 

sites has an association between an environmental pathway and a cancer cluster been 

documented. For this reason, the findings of the Toms River study are especially 

important. 

Reduce the burden of asthma 

Asthma is the fourth leading cause of work absenteeism and diminished productivity in 

the United States, resulting in nearly 12 million missed or less productive work days and 

12.8 million missed school days annually. Many air pollutants, such as particulate 

matter (PM2.5), can exacerbate asthma and cardiovascular disease. Surveillance data 

show that more than 16 million adults and nearly 7 million children in the United States 

currently have asthma. Additional data from the Asthma Call-back Survey, a component 

of CDC's Behavioral Risk Factor Surveillance System, revealed that two-thirds of adult 

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respondents who had ever had asthma met the criteria for active asthma. In addition, 

approximately one-third of adults who had ever had asthma had been advised by their 

health care providers to make changes to their environment to improve their asthma. 

CDC's National Asthma Control Program funds 36 state, local, and territorial programs 

and conducts several activities in support of asthma control programs and interventions 

that will prevent and reduce illnesses, injuries, and mortality related to environmental 

risk factors of asthma, especially in vulnerable populations. These activities include: 

supporting state and local partners to improve monitoring, identifying and tracking those 

most affected by asthma, and implementing science-based programs and activities 

leading to the reduction of asthma. 

The program also provides guidance for state monitoring and evaluation activities and 

assists in increasing the level of training for health professionals and the education of 

asthma patients and their families 

Strengthen health by reducing risks within the home 

Housing conditions can significantly affect public health. Childhood lead poisoning, 

injuries, respiratory diseases such as asthma, and quality of life issues have been linked 

to many of the more than 6 million substandard housing units nationwide. Residents of 

these units are also at increased risk for fire, electrical injuries, falis, rodent bites, and 

other illnesses and injuries. Other issues of concem include exposure to pesticide 

residues, indoor toxicants, tobacco smoke, combustion gases, and mold. 

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CDC's Healthy Homes program uses a holistic approach to address multiple health 

hazards in homes. The program also collaborates with U.S. Department of Housing and 

Urban Development (HUD), EPA, and Department of Energy (DOE) to provide 

coordinated federal approach to generate the greatest impact with limited resources. 

For example, CDC, HHS, DOE and HUD are working together on an effort so that when 

a weatherization crew enters a house to wrap a water heater or do an energy audit, the 

crew will check to see that the water heater is not set above 120 degrees F and if it is, 

reset the temperature to a safe level. Examples of hazards addressed collaboratively 

include asthma triggers, lead, improper waste water disposal systems, injury hazards, 

radon, mold, and vector-borne diseases. CDC provides state and local public health 

professionals with the training and tools necessary to address the broad range of 

housing deficiencies and hazards associated with unhealthy and unsafe homes. The 

potential for these programs is illustrated by the success of CDC's Childhood Lead 

Poisoning Prevention Program, which was established in 1990. Data from the National 

Health and Nutrition Examination Survey shows that the prevalence of elevated blood 

lead levels among children ages 1-5 years declined from 4.4 percent in 1991-1994 to 

0.6 percent in 2005-2006. ii 

Enhance environmental public health monitoring, tracking, and surveillance 

Measuring amounts of hazardous substances in our environment, traCing their spread 

over time, and understanding how they may cause illness are critical functions to 

environmental public health. Public health tracking systems that capture accurate 

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exposure and outcome data can facilitate public health efforts to prevent and control 

disease and disability linked to environmental exposures, CDC's National 

Environmental Public Health Tracking Network helps the nation accomplish this goal. 

The Tracking Network is a dynamic web-based data system that is used to track and 

report environmental hazards and the health problems that may be related to them, This 

system is unique, because for the first time, environmental data and public health data 

are available together in a central database and can be used to analyze the relationship 

between environmental hazards and health effects, The Tracking Network helps to 

facilitate efforts to monitor environmental public health trends on national and local 

levels, The Program partners with EPA and other federal, state, and local partners to 

include critical sources of data and information for the Tracking Network, 

The program currently funds 22 states and New York City to build and maintain local 

surveillance systems for data on non-infectious health conditions and environmental 

hazards, The program also supports surveillance that will result in data-driven public 

health actions such as analyzing area cancer rates for concerned citizens or identifying 

trends of pre-term births in a particular county, These actions have led to development 

of pesticide reduction policies in New York City and providing data to inform carbon 

monoxide detector policy in Maine, 
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Use biomonitoring to inform health priorities related to chemical exposure 

Biomonitoring is the science of directly measuring chemicals in human biological 

samples such as blood or urine. Biomonitoring data tell us the amount of a chemical 

from all sources combined (e.g., air, soil, water, dust, food) that is actually in a person's 

body. These data are valuable for a variety of public health purposes, such as 

identifying relative levels of exposure in the population, particularly in children or other 

vulnerable groups, and setting priorities for research into the health impacts of 

chemicals. 

CDC recognizes that biomonitoring is an important tool for helping to prioritize 

environmental chemicals for public health research. Biomonitoring fills a major gap by 

providing human exposure information that allows us to better assess the effectiveness 

of public health efforts to reduce exposure of Americans to specific chemicals. Data 

have shown that exposure to secondhand smoke in nonsmokers has decreased about 

70 percent, indicating that public health interventions to reduce exposure are working. 

Additionally, biomonitoring is an important component of ATSDR's exposure 

investigations. Understanding the potential for exposure and having the measurements 

of chemicals in the members of the concerned community allows for confirmation 

regarding whether or not a chemical, or naturally occurring compound, is being detected 

at levels that may be of concern. 
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CDC funds three states for state-based biomonitoring programs. CDC also funds 

capacity for biomonitoring through emergency preparedness programs, and the 

Tracking Network supplies funding for targeted biomonitoring activities. 

Core environmental health services 

CDC works to promote environmental public health by providing workforce training, 

supporting accredited academic programs, funding state and local capacity building, 

and providing scientific advice and expertise. These programs target environmental 

health professionals who work to ensure clean water, air, and food every day in 

communities across the country. Through programs such as the Environmental Public 

Health Leadership Institute, CDC provides leadership development and strengthens the 

environmental public health system's ability to provide high quality services. The 

Environmental Health Training in Emergency Response course provides state and local 

health departments with the skills to perform the many critical functions necessary 

following an emergency event, such as conducting shelter assessments, testing 

drinking water supplies, and controlling disease-causing vectors. 

Support healthy community design 

Designing and building healthy communities can improve the quality of life for everyone. 

Decisions about how to design communities have the potential to increase physical 

activity, reduce injuries and cardiovascular disease risk, and improve environmental 

health. The Healthy Community Design Program is an emerging component of CDC's 

work to strengthen the evidence base and practice of prevention. As an example, 

supporting work to promote safer built environments through collaborative partnerships 

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with the Safe Routes to School programs can ensure that kids have safe opportunities 

for physical activity as they go to and from school. CDC is also working with the 

Department of Transportation to provide health recommendations to transportation 

policy decisions. 

Address the health impacts of climate change 

World Health Organization estimates indicate that climate change claimed over 150,000 

lives globally in the year 2000. Health impacts of climate change are related to heat 

stress, waterborne diseases, poor air quality, extreme weather events, and diseases 

transmitted by insects and rodents. A robust public health infrastructure can reduce the 

potential for negative impacts. Although scientific understanding of the health effects of 

climate change is still emerging, there is a need to prepare for potential health risks as 

well as promote health-supporting adaptation and mitigation strategies. As the Nation's 

prevention agency, CDC is prepared to anticipate, prevent, and respond to the broad 

range of impacts on the health of Americans and the Nation's public health 

infrastructure. CDC, along with NIEHS, represents HHS in 14 federal partnerships on 

climate change science. In FY2009, Congress appropriated $7.5 million for CDC's 

Climate Change and Public Health Program. CDC's expertise and programs in 

environmental health, infectious disease and global health form the foundation of public 

health efforts in climate change. CDC's work addresses five broad areas: building 

climate change capacity at state and local health departments; developing partnerships; 

promoting workforce development; building the science base through research; and 

communicating health-related aspects of climate change. 

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Improve the public's access to safe drinking water 

Environmental conditions greatly influence the relationship between water and health. 

Millions of Americans live with the health threat of contaminated drinking water, 

especially in rural areas where improperly used or operated septic systems can be a 

significant source of groundwater contamination leading to waterborne disease 

outbreaks and other adverse health effects. CDC's Clean Water for Health Program, 

which includes the Environmental Health Specialist Network (EHS-Net) Water Program, 

works to identify, prevent, and reduce exposure to environmental contaminants in water. 

CDC's safe water activities include identifying risks from eating fish and seafood from 

water sources contaminated with mercury, algal toxins, and perSistent organic pollutants 

(POPs) and helping state and local public health officials identify vulnerable populations, 

implement interventions, and target funding to reduce the public's exposure. Currently, 

CDC is working to implement surveillance, research, and education related to small, 

sources (e.g., private wells), that are outside the scope of the Safe Drinking Water Act, 

and are thus unregulated by EPA. 

Conclusion 

In my dual role with NCEH and ATSDR, I have the opportunity to lead a highly 

dedicated group of people as they seek to provide answers on a wide variety of 

environmental issues related to human health. These issues range from identifying and 

addressing health risks related to hazardous substances, to developing an 

understanding of how the design of our communities impacts health. As we recognize 

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Earth Day, these activities provide us with an opportunity to appreciate the delicate 

relationship we have with our environment. 

Thank you for the opportunity to provide this testimony to highlight ATSDR/NCEH's role 

in Environmental Health. I look forward to answering any questions you may have. 

Endnotes 

; http://www.state.nj.us/health/eoh/hhazweb/dovertwp.htm 

;, http://www.epa.gov/envirohealth/children/bodLburdens/b1-graph.html; 

http://www.ncbi .nlm.nih.gov/pmclarticles/PMC2S69084/pdf/ehp-116-128S. pdf; and 

http://pediatrics.aappublications.org/cgi/reprintl123/3/e376 

House on on Health, 
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Mr. PALLONE. Thank you, Dr. Falk. We will now take questions 

from the members, and I will start with myself. And I wanted to 

start with you, Dr. Falk. 

I mentioned in my opening statement that making a link between an environmental hazard and the disease outbreak can 

sometimes be challenging for health agencies. In fact, you mention 

in your testimony that Tom’s River in New Jersey was one of the 

sites where you were able to make an association between an environmental situation and a disease cluster, but I can think of so 

many others, you know. The list is endless. I am thinking of the 

EPA administrator. She was recently at the Ramapo site, you 

know, where basically an old mine that Ford Motor Company, you 

know, deposited waste from their auto production and it is, you 

know, Native American, state-recognized reservation where, you 

know, every time I go up there, that is all that people talk about, 

the health impacts. And just recently, in the last week or so, we 

had our Region II administrator down to the Raritan Slag site 

which is in my district where there is all this slag from a national 

lead processing plant was deposited to create a sea wall. And now 

the beach is closed and of course when I went and we had our community meeting there with the administrator. A significant number 

of people said, well, that has been here since 1970. There has been 

no impact on us, you know. We have been swimming in it all this 

time. Now you have made it a Superfund site last fall and, you 

know, a lot people didn’t even believe that there was a problem 

from the health point of view. On the other hand, the regional administrator said it is probably one of the worst examples of, you 

know, potential health problems that she has witnessed in recent 

years. 

So there is all this controversy and I guess my question is why 

is it so difficult to prove that a given illness is a result of an environmental incident or situation and what are the barriers to making that determination? And is there anything we can do to improve the situation so it is easier for you to make those connections 

which oftentimes people think are obvious but don’t necessarily 

come back that way when the ATSDR, you know, investigates it? 

ATSDR has been involved in all those sites that I mentioned. 

Mr. FALK. So you are asking a very challenging question. ATSDR 

is a service agency, and it is very—we have a difficult product to 

deliver because of the challenges that you mentioned. So you know 

the volcanoes are in the news lately because of the eruption in Iceland, and early on in my career at CDC I worked at Mount St. Helens. And there was a mountain of ash fall, and it was all very similar substance. It was right there on the ground. And many people 

developed asthma as a result of it, and it takes minutes to hours 

to develop the asthma reaction to the ash fall. It is easy to measure 

the ash, easy to measure the asthma and the connection occurs in 

hardly any time at all. So it is easy to establish a relationship in 

a setting like that. 

The challenge for us at many of the Superfund sites is that the 

exposures may have occurred many years in the past. There are 

many different chemicals. They are hard to measure. You can’t always measure today what might have happened 20 or 30 years ago. 

On the disease end, some of these chemicals may cause many difVerDate Mar 15 2010 14:45 Jan 10, 2013 Jkt 076567 PO 00000 Frm 00043 Fmt 6633 Sfmt 6633 E:\HR\OC\A567.XXX A567

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ferent types of diseases, and although we have cancer registries, we 

don’t have registries for neurologic or other kinds of diseases that 

you have mentioned, and the connections may take decades to develop. Early in my career I worked with vinyl chloride. The cancer 

cluster that occurred among workers took 32 years from when vinyl 

chloride was introduced commercially until liver cancers were evident in the people. 

So these are real challenges. And we can’t change the circumstances. All these hazardous waste sites are what they are. 

They have occurred over time. 

I think the ways to improve this are one, better ways to more 

precisely measure exposures which is what we did in Tom’s River 

with extensive effort of modeling exposure. I think better ways to 

actually type and characterize the different kinds of cancers and 

diseases. You know, people doing therapeutics for drugs are now 

looking at molecular markers on different types of cancers, and 

maybe there are ways of better characterizing the diseases that we 

have to work on so that we can better link more precise estimates 

of exposure and more precise estimate—— 

Mr. PALLONE. Well, let me ask you this because I know my time 

is running out. Is there anything that we can do? I mean, is it a 

question of resources? Is it a question of authorization? Is there 

anything that we in Congress can do to help you better accomplish, 

you know, this goal of making those links or being able to, you 

know, investigate health links at these various sites? 

Mr. FALK. I think the opportunities to actually improve the way 

we can estimate, measure and model exposures, the better way to 

track disease and to do more than just cancer and those kinds of 

things would actually help going forward in the future. We can’t 

change the sites, but the better we can go forward at measuring, 

monitoring disease, measuring chemicals in people will enable us 

to do better linkages of those datum. 

Mr. PALLONE. I would just ask you, my time is running out, but 

if you can follow up in writing on this I would appreciate it because 

I mean, I cannot tell you how many times since I have been in Congress or even when I was in the state legislature that we would 

bring in, and I hope I get the acronym right, ATSDR or the State 

Health Agency in the case of New Jersey. And it was so frustrating 

because, you know, people, that was the main concern they had 

was, you know, what were the health impacts. And then even when 

remediation is done and you know some of these sites now have 

been cleaned up since I have been around so long, and you know, 

people still ask, was it cleaned up to satisfactory rates or levels so 

that, you know, there isn’t a health impact. Because oftentimes 

what happens is, you know, the sites are cleaned up. I am thinking 

of the chemical insecticide site in Edison which was the most hazardous waste site in the country and is now a recreation area, you 

know, like where people play ball. And I am not really getting any 

complaints there, I should say, anymore. 

But it is always a big issue for people in every state. What has 

happened so far? What is going to happen during clean-up? What 

is going to happen after clean-up? Because oftentimes they are 

used for recreational purposes. 

Mr. FALK. I would be happy to follow up on that. 


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Mr. PALLONE. All right. Thank you. The gentleman from Illinois. 

Mr. SHIMKUS. Thank you, Mr. Chairman. If you would hold on 

those slides first, let me ask these questions. 

Folks, Dr. Birnbaum, Dr. Falk, can you tell me what percent of 

the earth’s atmosphere greenhouse gases make up? 

Ms. BIRNBAUM. We are not focusing specifically on those issues, 

but we know the greenhouse gases that exist can have adverse impact on the health—— 

Mr. SHIMKUS. But you don’t know the percentage? 

Ms. BIRNBAUM. I do not know the percentage. 

Mr. SHIMKUS. OK. The answer is 2 percent of the earth’s atmosphere is greenhouse gases. Ninety-eight percent is nitrogen, oxygen, argon and other gases. Of that 1 to 2 percent of greenhouse 

gases, do you know what makes up the largest percentage? Ninetyfive percent of that 1 to 2 percent is water vapor. Of the 1 to 2 percent of the greenhouse gases that make up the earth’s atmosphere, 

can you tell me what percentage carbon dioxide is? 

Ms. BIRNBAUM. No. 

Mr. SHIMKUS. It is 3.62 percent. Now of this 3.62 percent, can 

you tell what makes up the largest percentage of carbon dioxide 

emissions in the earth’s atmosphere? No? The answer is nature 

makes up 96.6 percent of all carbon dioxide emissions. 

How about the percentage of carbon dioxide emissions from humans? If you do simple math, that is 3.4 percent. So humans overall contribute to any greenhouse effect to something like .28 percent of the earth’s atmosphere. If we would put the slides up? 

[Slide] 

Mr. SHIMKUS. They are probably hard to see from there, but the 

first one has the earth’s atmosphere and the little blue slice is 

greenhouse gases, just greenhouse gases. 

[Slide] 

Mr. SHIMKUS. The second slide is just the greenhouse gas. So you 

take that blue and that is magnified by the blue circle, the red part 

is carbon dioxide, which is 3.62 percent. 

[Slide] 

Mr. SHIMKUS. So then you take that red slice and you put it into 

the big circle next to it, 96.6 percent of that is nature, 3.4 percent 

is humans. So 3 percent of 3 percent of 1 percent is the human involvement in the climate change carbon dioxide debate. 

How do you all define hazardous in your research? Or do you 

when you do research on it? I mean, I am not diminishing the 

great stuff we have done on lead paint and stuff. When you are 

doing your research and you are trying to find something in the 

groundwater or in the earth, what is hazardous? What compels us 

to act? Dr. Falk? 

Mr. FALK. So when we think of things as hazardous, we are a 

health agency, and we are thinking of things that have potential 

impact on health. 

Mr. SHIMKUS. Right. So I mean, is there like a certain percentage 

or certain—it probably depends on the element, right? 

Mr. FALK. Yes. 

Mr. SHIMKUS. And how much is ingested by the individual, is 

that correct? 


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Mr. FALK. Right. And sometimes we have much better information on the relationship disease. Sometimes we are dealing with 

threats and risks and—— 

Mr. SHIMKUS. And that can change based upon—— 

Mr. FALK [continuing]. Dealing with probabilities over—— 

Mr. SHIMKUS [continuing]. As science and research continues. 

Mr. FALK. Sure. 

Mr. SHIMKUS. We can get more information, and there may be 

other contributing things that we don’t know that work together. 

Can anyone tell me how much carbon dioxide is hazardous to 

human health in parts per million? There is a federal standard for 

that. 

Mr. FALK. And we are not the ones who set that and—— 

Mr. SHIMKUS. But as a federal agency that does set that, do you 

know what that number is? 

Mr. FALK. I think that these are issues that are under discussion. I do not know the exact number. 

Mr. SHIMKUS. My point is I am trying to tie public health to 

other agencies. The answer is OSHA, which is a minimum standard, is 5,000 parts per million is hazardous to human health. Now, 

do you how many parts per million of carbon dioxide most of it, 96 

percent of it, naturally occurring is in our atmosphere? The answer 

is 350 to 390 parts per million. So if 5,000 parts per million is hazardous to human health by OSHA standards and the atmosphere 

has only 350 to 390 parts per million and that is what is viewed 

as hazardous, and 96 percent of that is naturally occurring, 

wouldn’t it be more a focus on us trying to stop the natural occurring carbon dioxide carbon emissions versus the man-made carbon 

emission, a cost-benefit return? 

Mr. FALK. Yes, if I may, maybe I could take one moment just to 

describe our role. 

We are not among the agencies like NOAA and EPA that are actually trying to do all these atmospheric calculations and doing the 

modeling that would actually predict and model climate change. 

What we are focused on at CDC and in our program is understanding that there are significant concerns about this. We are trying to support state and local health departments to assess potential vulnerabilities, to actually measure potential health effects 

that might be of concern and to think about ways to deal with it. 

Mr. SHIMKUS. Right, and I appreciate that. This is our only 

chance, again, as the minority to address issues. It is Earth Day. 

Climate change is—I mean, the Senate is going to raise energy 

taxes in their proposal coming out today. If we go to the last slide, 

the last one, the connection is this. 

[Slide.] 

Mr. SHIMKUS. The EPA has said that man-made carbon dioxide 

emissions is hazardous or endangers the public health. Now, you 

all know the ramifications and issues of public health. Many of us 

addressing the facts of the atmosphere, the amount of carbon dioxide is naturally occurring, 96 percent, the miniscule amount that 

is on this next slide, that is just of the carbon dioxide emissions. 

Now go to the middle one. 

[Slide.] 


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Mr. SHIMKUS. That little square goes up to the top. That is the 

perspective of the entire atmosphere and the carbon dioxide emissions and the man-made which is 1/3 of a 1/3 of a 1 percent. So 

we have to have our agencies talking, especially if they are going 

to make the claim that man-made carbon dioxide emissions endangers public health. And it is so miniscule, it is not even a blip in 

the atmosphere. This is on Earth Day, Mr. Chairman, and so this 

is the issue we wanted to address, and I yield back my time. 

Mr. PALLONE. Thank you. The gentlewoman from Florida, Ms. 

Castor. 

Ms. CASTOR. Thank you, Mr. Chairman. You know, when it 

comes to clean water and clean air and families all across the country just wanting the best for their kids and their parents and 

grandparents, it is striking to hear the stories here. You know, 

there is not a colleague here that didn’t have a story from back 

home of some contaminated neighborhood or a Superfund site. You 

all brought up other examples in your testimony, and you know, it 

is difficult to pick up the paper every day and not see some other 

chemical contamination in a community that is causing health 

problems. 

So when I think of folks back home and when they have questions and they see that some of their neighbors are having serious 

health effects, and maybe they live near a factory, it raises the 

question of what is that interaction with you all? I mean, I want 

to ensure that the environmental cops on the beat and the researchers really talk with local communities and neighborhoods. 

And maybe you could go through how the Agency for Toxic Substances housed within the CDC and the National Toxicology Program housed at the National Institute of Environmental Health 

Sciences at NIH connect with local agencies and communities and 

down to the neighborhood level to get to the bottom of chemical 

contaminants in communities and potential health risks and how 

can we further build those connections between your agencies and 

local health agencies and communities. 

Mr. FALK. Maybe to start, at CDC especially, and it is just not 

in the area of environment but broadly, whether it is infectious diseases or occupational health, we work very closely with state and 

local health departments. It is probably the most significant working relationship at CDC. So there is placement of CDC staff in 

state health agencies, constant planning with the organizations for 

the state and local health agencies and very frequent interaction 

opportunities to inter act with them. 

So yes, the state and local health departments are the front line, 

and we try to be as supportive as we can working with them, and 

depending on the complexity of the problem, you know, there will 

be additional federal resources that would actually help. 

At ATSDR, we actually have a cooperative agreement program 

with 30 different state health departments that have significant 

numbers of Superfund sites. We provide support to those state 

health departments to hire professional staff that they could otherwise not have to deal with toxicological questions, environmental 

health questions, specifically related to Superfund sites. So we do 

have 30 states where we work directly through staff that are hired 

through the cooperative agreement program with ATSDR. 


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So those are our programs working with state and local health 

people, and it is very important to actually have those people on 

the ground close to the communities where people have these concerns. But also we try to work very extensively across the Federal 

Government so we can do maximum benefit in terms of helping 

people. We work very closely with EPA, for example, at Superfund 

sites. We have ATSDR staff imbedded in the EPA regional office 

where they have their Superfund division so they can work closely 

together. We work very closely with our colleagues at NIEHS, and 

as Dr. Birnbaum will tell you, they are doing a lot of cutting-edge 

science on identifying what these chemicals can do, and our hope 

is to learn as much as we can from Dr. Birnbaum and be able to 

apply that local situation, utilize that to help state and local departments. So that is a very important working relationship for us. 

Ms. BIRNBAUM. So I will pick up on the relationship between 

ATSDR and NIEHS. As one of the examples of what we do, ATSDR 

actually sits as a member of the executive committee of the National Toxicology Program and helps us in deciding which compounds, which kinds of chemicals we should study, how we should 

study and what it means. Also on the executive board of the NTP 

sits EPA, OSHA, CPSC, National Cancer Institute—— 

Ms. CASTOR. Let me ask you. Put yourself in the place of a neighborhood then that, you know, maybe there has been some spill in 

the community or there is a factory and they are seeing some cases 

of cancer or in maternal health there have been serious issues. 

Give us some real-world advice on how right at the community 

level folks have the concerns that there is something in their 

water, there is something that they are breathing in the air, how 

they can—what steps do they need to take and then where you all 

play a role. 

Ms. BIRNBAUM. Well, in that specific example, for example, we 

have 14 Superfund research centers which are grantees programs 

throughout the country. These centers have a community engagement program and work very closely with the community and with 

for example the state departments of health in order to identify 

and deal with clean-up issues. We have these types of community 

engagement programs in all of our children’s health centers, in all 

of our breast cancer centers and in all of our environmental core 

centers. In addition, for example, I go out and hold community outreach meetings in different parts of the country, especially in areas 

where there is a great deal of concern about the environment. So 

I held one, for example, at Rutgers in the community last fall. I 

held one, for example, recently in Milwaukee which is an area of 

the great Rust Belt and huge concerns. I just got back from holding 

one in West Harlem in New York City to deal with and understand 

the concerns of the community. When we have issues of concern for 

example at a specific hazardous waste site, that is specifically the 

territory of ATSDR, and we work very closely with them. And we 

serve on some of their boards to help understand what are the 

chemicals, how can we communicate this information, and then 

more importantly, what we do is we develop methodologies to help 

remediate the problem. So we have actually developed, for example, little nanotechnology, nanoparticle impregnated discs that can 

actually remove volatile organic compounds from groundwater. We 


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have dealt with issues, for example, of mine tailings contaminated 

with arsenic or other metals where you actually use the 

phytoremediation approach and plant certain kinds of—in the 

desert it is brush—to keep down the mine tailings so they don’t 

blow around and expose people. 

So that will be the kind of thing that is NIEHS’ and NTP’s responsibility, to respond. We take nominations not only from other 

federal agencies but also from the communities at large about the 

things that concern them, and they enter our toxicity testing program as well. 

Mr. PALLONE. Do you want to add to that? I know we are about 

21⁄2 minutes over, but I would like you to finish answering the 

question. 

Mr. FALK. I was only going to say that for us being involved in 

those communities when it is important is actually very essential. 

As Chairman Pallone has said, we don’t always have all the answers but being able to be open, transparent and straightforward 

about it. So I have only been acting in this position for a short 

time, but in my previous stint at ATSDR, I tried to do a public 

meeting every month, and I tried to go to the most contentious 

ones so that we would get the rest of our staff engaged in those 

communities. And I think it is very important to be as engaged and 

open as possible. 

Mr. PALLONE. I would certainly agree with that. Thank you. Our 

Ranking Member of the Full Committee, Mr. Barton, from Texas. 

Mr. BARTON. Thank you, Mr. Chairman. Most of my questions 

are going to be directed to Dr. Birnbaum. Was your agency involved with the White House and the EPA on the analysis that led 

to the endangerment finding of CO2? 

Ms. BIRNBAUM. No, we were not. 

Mr. BARTON. Why not? 

Ms. BIRNBAUM. Our mission is to study the health effects, and 

the World Health Organization in 2000 estimated that there were 

over 160,000 deaths a year from increases in climate change. We 

know that by some immediate mitigation of some of the things like 

air pollution we can have immediate tremendous benefits in terms 

of reducing the mortality and the illnesses associated, for example, 

with air pollution associated with climate change. 

Mr. BARTON. Well, I will be honest, I am stunned. I know you 

are telling the truth, so I am not stunned that you are telling the 

truth, but your mission statement says NIEHS, broad focus on environmental causes of disease make the institute a unique part of 

the NIH. And then over here it says under the subtopic, climate 

change and human health, climate change and the actions taken 

to address it will have significant effects on human health. NIEHS 

is taking a lead among federal agencies to understand the health 

effects of climate change and to identify who may be most vulnerable. 

We have this major endangerment finding that has huge consequences for the American economy, and the institute at NIH that 

is responsible for examining those causes is not involved at all. I 

mean, I don’t understand that. 

Ms. BIRNBAUM. OK. I would like to clarify. We have taken the 

lead role across the Federal Government in helping to organize the 


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development of a white paper which calls for basically a research 

agenda on the understanding of what the research should be to understand the health impacts of climate change. EPA was involved 

but not the group that does the endangerment findings. But EPA 

was involved along with CDC, NOAA, Department of Transportation, Department of Agriculture and others in the development of 

this document which lays out in a usable manner the various type 

of health impacts that can be induced by increase in the climate 

change, many things that have been identified by the World Health 

Organization. 

Mr. BARTON. Well, let me ask you. You are a professional toxicologist, I believe. Is that correct? 

Ms. BIRNBAUM. Yes. 

Mr. BARTON. So I mean, you know poison. Is that correct? 

Ms. BIRNBAUM. I hope it is correct. 

Mr. BARTON. I am not saying you cause poison, I am just saying 

you know it. Is CO2 a poison? 

Ms. BIRNBAUM. Well, at very high concentrations we know at 

CO2 can actually cause death, but that we are talking about concentrations much, much higher than the kinds of concentrations for 

which the concern—— 

Mr. BARTON. I mean, if I drink a Coke, I drink CO2, don’t I? 

Ms. BIRNBAUM. Absolutely. CO2 is a natural product, as Mr. 

Shimkus has mentioned. 

Mr. BARTON. So I mean, in the classic sense, the average person 

would identify as a poison, CO2 is not a poison? 

Ms. BIRNBAUM. Paracelsus taught us in the 1500s that poisons 

are a matter of both dose and timing and—— 

Mr. BARTON. Does CO2 cause cancer? Is there any evidence that 

CO2 is a carcinogen? 

Ms. BIRNBAUM. Not that I know of. 

Mr. BARTON. OK. And I don’t know what the temperature of liquid CO2 is, but if CO2 that we put in a pipeline, there are CO2

pipelines, if there was a rupture in the pipeline and I was standing 

by the rupture and all the CO2 came out of that pipeline and I was 

exposed to it, would that cause any kind of a health effect on me? 

Ms. BIRNBAUM. It would depend on the concentration. It could 

put you to sleep and eventually in fact—— 

Mr. BARTON. I mean, it could suffocate me, I guess, and prevent 

oxygen—— 

Ms. BIRNBAUM. It could suffocate you. In fact—— 

Mr. BARTON. But if I am just exposed to it, it wouldn’t impact 

my health, would it? 

Ms. BIRNBAUM. Low concentrations would not impact your health 

individually. 

Mr. BARTON. So in any normal context, CO2 is not a danger to 

me as a person? 

Ms. BIRNBAUM. We are producing and exhaling CO2 ourselves all 

the time. 

Mr. BARTON. Exactly. 

Ms. BIRNBAUM. Some of the issues about, for example, greenhouse gases that directly affect human health are things like, for 

example, black carbon which not only raises, you know, increases 

the temperature but also for example has immediate impacts on 


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human health. And we know that elevated particulate matter, for 

example, in the air is associated with increased level of illness, cardiovascular disease, pulmonary—— 

Mr. BARTON. But CO2 is not particulate matter. 

Ms. BIRNBAUM. No, I am talking about other kinds of greenhouse 

gases. 

Mr. BARTON. My time is expired, Mr. Chairman. I just think it 

is unusual that the agency that is responsible for researching and 

examining the environmental consequences of climate change 

wasn’t involved in the endangerment finding. And I think it is also 

somewhat enlightening to know that as we normally define a hazardous material or poison, that CO2 is not one. And I want to 

thank you for giving an honest answer. I won’t say it is refreshing 

because everybody is supposed to be honest, but it is comforting. 

I wish you the best, each of you the best in your agencies. 

Ms. BIRNBAUM. Thank you. 

Mr. BARTON. Thank you, Chairman Pallone. 

Mr. PALLONE. Thank you. I just found out you have an engineering background. I didn’t know that. 

Mr. SHIMKUS. I do. Old engineering. I am still certified by the 

State of Texas. I don’t use my certification. 

Mr. PALLONE. All right. 

Mr. SHIMKUS. I don’t want to endanger human health by using 

that certification. 

Mr. PALLONE. Thank you. The gentleman from Maryland, Mr. 

Sarbanes. 

Mr. SARBANES. Thank you, Mr. Chairman. I appreciate it. I 

apologize for coming in late. I did look at the testimony that you 

submitted, and Dr. Falk, I just wanted to ask you a question. I am 

the author here of a piece of legislation called the No Child Left 

Inside Act which is an effort to promote environmental education 

and in particular, integrate outdoor education and outdoor opportunities for young people across the country as part of developing environmental literacy. We have had hearings which testify to the instructional benefit of this kind of education to the economic opportunities through career paths that are formed when young people 

are exposed in that way to obviously the benefit of raising their 

awareness of the environment, which helps all of us. But there was 

also very strong testimony about the public health benefit of getting children outdoors more active and really integrating that into 

the instructional program and also then modeling for parents and 

for partnering with parents and families how you just promote an 

active and healthy lifestyle. 

And so I was intrigued by this healthy community design concept 

that CDC is developing and strengthening, and you gave examples 

of safe routes to school programs and described them as safe opportunities for physical activity as they go to and from school. And I 

just wondered if you could speak to that a little bit more. I have 

talked to some of the folks in school construction, for example, 

about integrating into the future design of schools and renovations 

of schools the concepts of outdoor classrooms and other opportunities for students to kind of take ownership of the environment in 

the immediate vicinity of their school and so forth. And I was just 

curious your perspective on the extent to which an effort like No 


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Child Left Inside promotes that kind of outdoor educational opportunity can align with the healthy community design approach that 

CDC has developed. 

Mr. FALK. I think it is a very strong connection with what you 

raised and kind of what we are thinking. 

You know, there are traditional environmental issues such as 

specific chemicals and how they affect people, but increasingly as 

we see the environment broadly, the impact of how the environment has been built, changes that have occurred over time, children’s ability to be out and do things has really been impacted tremendously by how we have structured our world over the last 10, 

20, 30 years. And I used to walk to school 30 minutes every day. 

My children never dreamed of that. 

So we think it is very important to actually look at how we have 

designed our homes, our communities, our schools and how we can 

think about these in a way that would promote healthy behaviors, 

as well as an appreciation of the environment. So Safe Routes to 

School, we think about that. We think about walking, biking trails 

and ways in which people can enjoy the outdoors. And I mentioned 

also in testimony the President’s Task Force on Children’s Environmental Health. There will be an opportunity to actually really discuss these issues and to be able to make further advances in these 

efforts, and you are very correct that education is a very important 

part of that, both the environment of the schools itself but what we 

are actually teaching children about their environment and the 

outdoors. 

So that is a very important issue to us, and I hope that we are 

receiving—well, in the President’s budget for fiscal year 2011, there 

is an element for community design, and I know that issues related 

to education and the environment, health impact assessments of 

the environment are all very important to us. 

Mr. SARBANES. Well, that is great to hear. I mean, in a sense, 

if we can inculcate as the norm this idea of getting kids outdoors, 

we don’t want to have a situation of, you know, they are all dressed 

up with no place to go, right? And so the healthy community design 

will help ensure that when they are ready to go out into that outdoors and engage, that we have designed those opportunities in a 

way that really maximizes what is available to them. 

Mr. FALK. I think I also mentioned in testimony that last week 

at the White House there was the Conference on America’s Great 

Outdoors which I think deals more broadly with conservation and 

the broader outdoor environment. But I think that is another avenue for bringing together federal agencies to actually focus on the 

outdoor issues. 

Mr. PALLONE. Thank you. Next is the gentleman from Texas, Mr. 

Burgess. 

Mr. BURGESS. Thank you, Mr. Chairman. Dr. Falk, you mentioned when you were discussing with Mr. Pallone a lack of disease 

registries, specifically those covering neurological diseases. There is 

a bill that has been introduced, H.R. 1362, to create a registry for 

MS, Parkinson’s and other neurological disorders. Can I assume 

then by your answer to Mr. Pallone’s question that you are in support of that and you would encourage Chairman Pallone to bring 


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that bill to the Subcommittee for a markup? The witness answered 

yes for the record. 

I am going to ask a series of questions that may seem off-topic 

on Earth Day, but we get so little chance for oversight of federal 

agencies on this committee, and it is really a shame because this 

committee should be the primary committee for oversight, perhaps 

not this Subcommittee but the Subcommittee on Energy and Commerce. 

But let me ask a couple of questions related to, Dr. Birnbaum, 

Title 42, salaries and Title 42, appointments. Are you familiar with 

those? 

Ms. BIRNBAUM. We have several. 

Mr. BURGESS. An it seems that our committee staff has received 

information from inside the institute that the National Institute of 

Environmental Health may not be using Title 42 special pay mechanisms according to the regulations and guidelines. Now, as I understand Title 42 regulations, they allow you to pay outside of the 

traditional pay guidelines for someone with special expertise who 

will provide special services, is that correct? 

Ms. BIRNBAUM. It is outside of the regular, normal GS pay scale 

and requirements, and it is a very special program and it is a very 

complex program with many different sub-programs within it. 

Mr. BURGESS. And typically, though, those individuals who are 

hired under Title 42 would go through a review process, a peer review process, to receive that designation? 

Ms. BIRNBAUM. That is my understanding since I have been at 

the institute. You know, I have been there for 15 months now. 

Every hire that might be a Title 42 goes through extensive hiring 

process that not only goes through processes at our institute but 

goes through central panels at NIH. 

Mr. BURGESS. How many hires under Title 42 provisions in the 

last 15 months? Would you be able to put a number to that or is 

that something you would need to check and get back to us on? 

Ms. BIRNBAUM. I would have to check and get back to you, but 

it has been very few. 

Mr. BURGESS. Few like under 12, few like under 50? 

Ms. BIRNBAUM. Definitely way under 12. 

Mr. BURGESS. OK. But again, there is at least a perception and 

it comes from the NIEHS that it may be more of a routine practice 

than something that is used under exceptional circumstances, and 

while that may be an internal problem within the institute, it is 

something that should interest members of this committee that the 

Title 42 provisions are being appropriately applied and the conditions are being followed. 

Ms. BIRNBAUM. I will be happy to look into it, but I didn’t know 

that this was a concern since I have been at the institute. 

Mr. BURGESS. Are you approving Title 42 conversations for higher salaries based on job title or does that require a pay committee 

to provide a recommendation? 

Ms. BIRNBAUM. The pay committee has to provide recommendations, and there is a very extensive documentation that is required. 

Mr. BURGESS. Let me just ask this question. Are you employed 

under Chapter 42 provisions? 

Ms. BIRNBAUM. Yes, all institute directors are. 


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Mr. BURGESS. Can I ask what your salary is? 

Ms. BIRNBAUM. I guess so. 

Mr. BURGESS. I would ask what your salary is. 

Ms. BIRNBAUM. It is $230,000 a year. 

Mr. BURGESS. OK. And prior to coming to the National Institutes of Health, public records of your salary at EPA, $158,000 according 

to what I have been able to find. Is that accurate? 

Ms. BIRNBAUM. That sounds right. I was in the senior executive 

service. 

Mr. BURGESS. Now, in March, Director Francis Collins—and I 

have the absolute utmost respect for Dr. Collins and I think he is 

the right man at the right time in the right place—he stated that 

the Obama Administration has made it clear that cancer and autism ought to be priorities for medical research and that we totally 

agree, we meaning Dr. Collins and the NIH. Now, currently, for 

issues related to climate change, what is the funding level? 

Ms. BIRNBAUM. It is a very complex issue. One of the analyses 

suggests that maybe at all of NIH as much as I think $300 million. 

Others suggest it is only about $1.5 million. And it depends upon 

whether you count the research that might be related to effects of 

climate change but wasn’t directly tied to it, that is the first figure, 

versus the studies that have just been, most of them just recently 

initiated with funding through the stimulus package where we actually ask for grants that would directly look at the relationship. 

Mr. BURGESS. Yes, we will get to the stimulus package in just a 

second if I have time. My figure actually falls in between those two 

that you gave, so it must be accurate, $200 million. But currently 

the figure that I have for autism is $188 million. Is that a correct 

number? 

Ms. BIRNBAUM. And that is for the entire NIH. That sounds like 

it is in the ballpark. 

Mr. BURGESS. So Dr. Collins said the highest priority is cancer 

and autism for medical research, yet funded science for climate 

change actually outstrips that for funding for autism at the present 

time. 

Ms. BIRNBAUM. As I said, part of that has to do with the way that our system counts work, and when it includes the $200 or the 

$300 million figure it is counting all the work for example that 

might be related to the impacts of air pollution, the impacts of 

heat, the things that can happen when infectious disease patterns 

change as the climate rises and so on. But many of those were not 

directly related to climate change. 

Mr. BURGESS. On the stimulus bill which you referenced a moment ago, my figures are that your institute received $187 million 

from the American Recovery and Reinvestment Act. How have 

these funds been allocated to climate change related activities? 

Ms. BIRNBAUM. The climate change activities that we funded 

were actually funded through the common fund that the director 

of NIEHS had held back $200 million from the amount, the rest 

of the $10.4 billion that was allocated, and that was what was 

called the Challenge Program. And through the Challenge Program 

NIEHS funded two grants, one dealing with the direct effects of 

heat waves on health and one dealing with the increase in forest 

fires and what that would do in terms of cardiovascular respiratory 


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disease. The total amount of challenge grants that were funded on 

climate change under the Challenge Grant Program was about $1.3 

million in fiscal year 2009. 

Mr. BURGESS. Can you tell us how many jobs were created under 

the climate change funding that was provided to your institute? 

Ms. BIRNBAUM. I can get you that information. Under our $187 

million, we know that at least 400 jobs, new jobs, were created. 

Mr. BURGESS. And of the $38 million total that was received by 

NIH, how much of that was received by your institute, specifically 

for climate change activities? 

Ms. BIRNBAUM. Well, as I said, we funded two grants under cli- mate change that came from this $200 million. So it is a very small 

percent of the total budget. I think one thing that is important is 

this white paper, this cross-agency white paper that has just been 

released which identifies and provides a roadmap for the research 

needs related to health impact of climate change will help us as we 

go forward to better understand the health impacts. 

Mr. BURGESS. Again, just for the record, tell me the number of 

jobs that your institute created as a result of the climate change 

funding in the stimulus bill? 

Ms. BIRNBAUM. I can’t give you exactly the number, but it would be—I don’t have that number. I know how many the whole $187 

million created, and that was approximately 400 new jobs. Now, 

those numbers are based upon what our grantees tell us the number of jobs that they created. 

Mr. BURGESS. So $.5 million a job? 

Ms. BIRNBAUM. That would be—that does not include, and I 

think it is important to realize, all the jobs that in addition, jobs 

that weren’t lost, for example, that would have been lost. 

Mr. BURGESS. OK, so we are in the created or saved category 

now that Vice President Biden talks about. If you would get us the 

number, if you could. If you would get us that number from your 

institute—— 

Ms. BIRNBAUM. I will get you—— 

Mr. BURGESS [continuing]. I think that would be helpful—— 

Ms. BIRNBAUM [continuing]. For our two climate change grants 

how many jobs the grantees told us that that created. 

Mr. BURGESS. That would be great. Thank you, Mr. Chairman. 

I will yield back. 

Mr. PALLONE. Thank you. Gentleman from Georgia, Mr. Gingrey. 

Mr. GINGREY. Thank you, Mr. Chairman. Dr. Birnbaum, how important do you think it is to base policy decisions on strong science? 

Let me repeat that. How important do you think it is to base policy 

decisions on strong science? 

Ms. BIRNBAUM. I think strong science input into policy is extremely important. 

Mr. GINGREY. Dr. Falk. 

Mr. FALK. I can’t even imagine the reverse, basing policy decisions on poor science. I mean, I totally agree with that statement. 

Mr. GINGREY. Recently the Yucca Mountain Nuclear Waste Repository was cancelled. Do you know, either one of you, do you 

know of any federal health-based science research studies on which 

this decision was based or any safety studies? Are you aware of either? 


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Mr. FALK. I don’t think that we at CDC were ever engaged in 

that process on Yucca Mountain, so I don’t actually know that in 

any kind of detail. 

Mr. GINGREY. Dr. Birnbaum, do you have any knowledge of 

whether or not the decision was based on any federal health-based 

science research studies or safety studies? 

Ms. BIRNBAUM. I don’t know of that. 

Mr. GINGREY. Either one of you really have any knowledge of 

why the Yucca Mountain Nuclear Waste Repository was cancelled 

after getting so close to completion and I don’t know how many—— 

Ms. BIRNBAUM. We were never consulted. 

Mr. GINGREY. You weren’t involved in that? OK. Dr. Birnbaum, 

you testified that new understanding heightens the need to protect 

people at critical times in their development, and you presented actually a range of newly understood risk to DNA and the like. What 

is the bottom line in your view? Are we healthier now than we 

were 50 years ago or not? And if you could elaborate on that and 

maybe provide some data, I would appreciate it. 

Ms. BIRNBAUM. Well, I think that infectious diseases have been 

a success story over the last century, that basically many of the 

diseases that people died from in the past we have been able to 

allow people to live longer, healthier lives. However, the increase 

in chronic diseases certainly has been dramatic over the past century and continues. The very, very rapid increases in health conditions such as diabetes, autism, ADHD, for example, are all issues 

that have occurred so rapidly, and I think most scientists would 

agree that studies clearly show that it is just not a matter of diagnosis but is in fact an actual increase that it can’t be changed just 

in our genes. It has to be a change in our environment. And I think 

we are beginning to understand that complex diseases in all cases 

are going to reflect an interaction between genes and our environment. So for things like autism, for example, and ADHD as just 

two examples, the increases in those again have occurred so rapidly, CDC in fact has recently come out with new information 

which demonstrates that now 1 in every 110 children is diagnosed 

with an autism spectrum disorder. That again is happening too 

quickly. The issue of some of the new understandings that during 

development, the expression of genes change, and if you alter that 

expression of genes at critical times, in fact, you can never recover 

from that insult. So I think those are the important—— 

Mr. GINGREY. Yes. Well, let me just say that I think the answer 

to that question is that we are healthier today than we were 50 

years ago. Certainly there are more chronic diseases, but of course, 

people are living longer and they are developing osteoporosis and 

obesity and a number of things that may very well be related to 

their own behavior or lack of it, personal responsibility. 

Let me go on to my last question because we don’t have much 

time. I don’t have much time at this point. And I want this to be 

a series of yes and no, so just simply answer yes or no. I would like 

for both of you to do this. Do you believe that good science includes 

relevant, verifiable measurements with sufficiently small error 

rates? Would you agree with that, yes or no? 

Ms. BIRNBAUM. Yes. 

Mr. FALK. Yes. 


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Mr. GINGREY. Do you believe that good science includes controlled measurements whose interpretation is not authored by outside influences? 

Ms. BIRNBAUM. Yes. 

Mr. GINGREY. No trick questions here. Thank you. You both say 

yes. Do you believe that good science contains results that are repeatable by independent scientists? Dr. Falk is shaking his head 

yes. Dr. Birnbaum. 

Ms. BIRNBAUM. The answer is if they truly try to repeat the 

study. 

Mr. GINGREY. Yes, and assuming they did. So the answer from 

both of you is yes. And finally, do you believe that regulatory policy 

in the United States, things that we do, to the extent that it is 

going to rely on scientific research should, at a minimum, make 

these criteria that you have agreed to, we just mentioned, the cornerstone of our policymaking? 

Ms. BIRNBAUM. Yes. 

Mr. GINGREY. Dr. Falk. 

Mr. FALK. Yes, sir. 

Mr. GINGREY. Thank you all very much. And for the record, in 

case you couldn’t hear, the answer to all those questions is yes. Mr. 

Chairman, thank you for your indulgence. I know I am a little bit 

over, and I yield back. 

Mr. PALLONE. Thank you. The gentleman from Pennsylvania, Mr. 

Pitts, has 8 minutes. 

Mr. PITTS. Thank you, Mr. Chairman. I apologize. I had to step 

out for a few minutes. I hope I don’t ask you about what you have 

already spoken. 

Dr. Birnbaum, you testified that new understanding heightens 

the need to protect people at critical times in their development, 

and you presented a range of newly understood risks to DNA and 

the like. Are we healthier today than we were, you know, 50 years 

ago in your opinion? What is the bottom line? 

Ms. BIRNBAUM. More people are living longer. 

Mr. PITTS. And how do the new health risks that you have talked 

about compare with the risks that contributed to disease and development 50 years ago, for instance? 

Ms. BIRNBAUM. Some of the new understanding is making it 

clear that exposures or effects in early life can lead, be associated 

with, the increase in chronic disease that we are seeing. So studies 

have clearly shown that, for example, some under-nutrition, not 

necessarily starvation, but under-nutrition or stress can be associated 40, 50, 60 years later with an increase in obesity, diabetes, 

cardiovascular disease and cancer. 

Mr. PITTS. Now, you talked about risks with environmental toxins. Are you studying naturally occurring toxins as well? Have you 

examined whether there are more natural or more man-made toxins in the environment? 

Ms. BIRNBAUM. Under the NTP, we have actually studied over 

2,700 individual substances, and included in that list are at least 

100 to maybe more natural products. 

Mr. PITTS. And should we be concerned with these natural—— 

Ms. BIRNBAUM. Some of those products are carcinogenic. 


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Mr. PITTS. And what kind of priorities do you place on research 

to identify, to show the health improvements from reductions in 

the toxins you identify? 

Ms. BIRNBAUM. Much of the research that we do is driven by the 

nominations that we get and is also by the priorities, trying to understand and look at things that are either highly toxic or things 

that can have the opportunity to impact large numbers of people. 

So we talk about very often how broad is the exposure, and that 

is often a determinant of whether we study a chemical in detail or 

not. 

Mr. PITTS. Now, one of the quotes in your testimony, you said the 

Center for Children’s Environmental Health actively supports the 

engagement of new community groups involved with children’s 

health issues. What do you mean by that statement? 

Ms. BIRNBAUM. OK. We have 14 children’s health centers that we 

co-fund with EPA, and these centers, in addition to having all the 

scientific parts which involves basic research and some human 

studies, also involve a community outreach group. For us to go into 

a community and work in a community, we need to have the citizens of that community involved from the start of the studies to 

the completion and then help us in the development of materials 

that can be used to help communicate what we learned. 

Mr. PITTS. Now, are some of these groups advocacy groups? 

Ms. BIRNBAUM. Some of the community groups are advocacy 

groups. 

Mr. PITTS. And what kind of advocacy do you support? 

Ms. BIRNBAUM. Well, for example, the We Act group in New York 

City which is involved with our Columbia’s Children’s Health Center is very involved. For example, they have played a major role in 

helping New York deal with issues of, for example, waste transfer 

stations, diesel exhaust, developing of parks and so on. 

Mr. PITTS. OK. Thank you. Dr. Falk, in your opinion, is our environment in better shape today than it was 50 years ago? 

Mr. FALK. I think we actually have made great strides in the last 

50 years. 

Mr. PITTS. And are we healthier today in your opinion than we 

were 50 years ago? To what extent, you know, as technological advances occur, innovation, has that contributed to our health? 

Mr. FALK. Yes, in many ways we have improved significantly as 

Congressman Gingrey said before. Heart disease rates are coming 

down, longevity goes up. But there are clearly concerns such as increase in rates of obesity in children and actually how to weigh 

those in terms of—I wish CDC had a health index that we measure 

week to week how the Nation’s health would go. But that is a complicated thing to put together. So yes, we have made tremendous 

advances in many chronic diseases. That is not to say there aren’t 

worrisome issues that come up. 

Mr. PITTS. In terms of threats to the environment, does CDC examine environmental and human health in the context of economic 

well being of people? 

Mr. FALK. In context of, excuse me? 

Mr. PITTS. Economic well being of people and communities? 

Mr. FALK. Well, I think what happens is that in many of the 

places where we work, such as at ATSDR working at Superfund 


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sites, many of those sites are in areas where people are economically disadvantaged or impoverished. So inevitably that happens, 

and it is a challenge for them and for us. And so it compounds the 

issues that we have to deal with when we speak with them. They 

often don’t have adequate healthcare, and they are concerned about 

healthcare for their exposure with chemicals and so on. So there 

are ways in which I think the economic difficulties of people around 

Superfund sites compound the scientific and environmental issues. 

Mr. PITTS. What role does economic well being have on the ability to prepare for climate change, for instance, be it natural or 

man-made? Will CDC study that? 

Mr. FALK. In terms of climate change? 

Mr. PITTS. Yes. 

Mr. FALK. We have a program that the appropriation is roughly 

$7.5 million, and our role is particularly to work with state and 

local health departments and others to understand local 

vulnerabilities that might appear from changes in the climate, establish surveillance so those things can be tracked. For example, 

communities which have had issues with heat-related mortality 

and illness in the past, to be able to track that as a change and 

to understand how do you measure that and how one might mitigate that if that increased in the future. 

Mr. SHIMKUS. Will the gentleman yield on that real quick? 

Mr. PITTS. Yes. 

Mr. SHIMKUS. Are you also looking at cold-related injuries—— 

Mr. FALK. Cold-related? 

Mr. SHIMKUS [continuing]. In response to—I mean, there is an 

argument. Heat-related injuries may go up, cold-related injuries 

may go down. So hopefully you are looking at the benefits and the 

disadvantages if you are focusing on one health-related event. 

Mr. FALK. I think in one sense, we actually look at the final common denominator. If the heat is increasing, what is that doing to 

the health of people? We try to work with other agencies such as 

energy, transportation—— 

Mr. SHIMKUS. No, but, come on. You got to be fair, here. If you 

are looking at the negative effects on health because of heat increases, you have to look at the positive effects if there are coldrelated injuries or diseases or deaths, and that is mitigated by a 

warming climate. You can’t—— 

Mr. FALK. You said cold? Did you say cold, c-o-l-d? 

Mr. SHIMKUS. Yes. 

Mr. FALK. OK. I am sorry. Yes, that is an important issue. We 

understand that. And we—— 

Mr. SHIMKUS. Well, I don’t think the Administration does. 

Mr. FALK. Yes. 

Mr. SHIMKUS. So I would applaud you if you are making sure 

that there is a fair—— 

Mr. FALK. We have—— 

Mr. SHIMKUS [continuing]. Look at the cost benefit and disadvantages of any effective climate change. I am sorry to take the gentleman’s time. 

Mr. PITTS. Thank you. My time is expired. Thank you. 

Mr. PALLONE. Thank you. The gentlewoman from North Carolina, Ms. Myrick. 


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Mrs. MYRICK. Thank you, Mr. Chairman. Thank you both for 

being here, and I am sorry I missed your opening testimony. I am 

very glad, Dr. Birnbaum, that you are in North Carolina. We are 

happy to have your agency there, no question about it. 

I wanted to ask you a question about the Breast Cancer and Environmental Research Act that was passed in the fall of 2008. The 

goal was of course to improve the links between breast cancer and 

environmental, you know, factors. But could you go into a bit more 

detail about the status of that and where it stands right now and 

the provisions of the bill? 

Ms. BIRNBAUM. Yes. Thank you for your help in establishing that 

bill. NIEHS and NCI both, already before the bill was passed, had 

three Breast Cancer in the Environment Research Centers. We 

have just in fact requested renewal of those and gotten in the proposals, and we have been getting a lot of information. And those 

are prospective studies where we are actually recruiting young 

girls before puberty to look for environmental impacts on changes 

in their mammary gland development to see what might predispose 

to breast cancer later on. 

As far as the Breast Cancer Environment Act, we have now 

formed the FACA panel that was part of the requirements of the 

Act. It took quite a while actually for the authority to come down 

to us to form that panel, and we are looking to have the first meeting of this advisory panel that will involve six federal scientists, six 

non-federal scientists and six community groups or representatives 

of advocacy groups. And that committee is anticipating having its 

first meeting hopefully in July. 

Now, in addition, as I said, we fund about $30 million right now 

at the NIEHS in word-related to breast cancer and the environment. The centers again are co-funded with NCI, and we are very 

excited in part because some very interesting work has come out 

showing at least that in animal models, that early life exposure can 

actually predispose to breast cancer later on. We have also, for example, by measuring chemicals that are present in these young 

girls that we have recruited in three very different communities, 

we have found in fact in one of them, near Cincinnati, we found 

presence of a chemical of great concern at very elevated levels in 

these young girls, but it is allowing us to identify the source of that 

chemical exposure and clean it up so that we prevent further exposure from going on. 

Mrs. MYRICK. Good. Well, I will be interested when you get the 

panel together if it is not too much trouble and you can let our office know. And I would be very interested in how the first meeting 

goes. 

Ms. BIRNBAUM. We will be happy to, and we will also be happy 

to send you the list of the members of the committee. 

Mrs. MYRICK. That would be good, too. Thank you. I appreciate 

that. And for both of you, Dr. Falk as well, can you speak to your 

ability as leaders of both of your major organizations to share findings and data with other HHS entities like FDA and then the EPA 

for instance? And do the conclusive findings at ATSDR or NIEHS 

regarding specific chemicals end up affecting pending product approvals or regulatory reviews at EPA and FDA? 


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Ms. BIRNBAUM. Well, for example, FDA in January announced 

that the chemical BPA was of some concern, and that was really 

in large part based upon the findings of our Center for the Evaluation of Risk to Human Reproduction which had convened an expert 

panel and involved a lot of outside witnesses as well and developed 

a report which concluded that there was some concern about BPA, 

and FDA now shares that concern. We work very closely with the 

FDA for example. They are a full partner in the National Toxicology Program and are very involved not only in the nomination 

of substances and evaluating the studies but actually we work with 

them in the conduct of a number of the studies that are carried on 

at the National Center for Toxicological research in Jefferson, Arkansas. In addition, we work very closely and provide information 

to EPA. So for example one of the things that NIEHS is mandated 

to do is issue a report on carcinogens which lists chemicals as 

known or anticipated to be likely human carcinogens. And the EPA 

has just decided that they will use that report as definitive information and will not need to do their own hazard assessments on 

those chemicals. 

Mrs. MYRICK. Dr. Falk. 

Mr. FALK. Yes, Dr. Frieden, the new director of CDC, has made 

it I think a very high priority to work closely with the FDA, and 

that covers a broad range of issues from toxic chemicals to nutrition to smoking. You know, for example, FDA has a new Office of 

Smoking and Health, and we have at our toxicology laboratory a 

significant ability to look at toxic chemicals in cigarettes and smoke 

and people. And so we are able to provide them information on 

what we know about work like that. So that is a very high priority. 

And historically we have always had a very close relationship with 

EPA. That is a very important one to us. 

Mrs. MYRICK. Well, it is important because of what EPA does 

and how they do things and the science or whatever you would call 

the different reasons behind the statements they make and the regulatory effects that they have on different chemicals et cetera or 

products. 

Ms. BIRNBAUM. I would like to just add that EPA also serves on 

our executive board of the NTP, so in fact we have a meeting this 

afternoon, and Dr. Falk is on our executive board. And for example, 

Steve Owens, who is the Assistant Administrator for Toxins and 

Pesticides is on our board as is Paul Anastas who is the Assistant 

Administrator for the Office of Research and Development at EPA. 

Mrs. MYRICK. Very good. Thank you both, and thank you, Mr. 

Chairman. 

Mr. PALLONE. Thank you. I think we are concluded, but I did 

want to say first of all, I should mention that members may submit 

written questions to you usually within 10 days, and obviously we 

would like you to get back to us with responses as soon as possible. 

I know that some members have already asked and are going to 

follow up with some written questions, and we appreciate the response. 

Mr. SHIMKUS. Mr. Chairman? I don’t know if we asked for unanimous consent that all written statements could be submitted. 

Mr. PALLONE. Without objection, so ordered. I just want to say 

that I guess it is maybe obvious from what I have said that what 


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you do is very important, and you know, this was an oversight 

hearing. It wasn’t a legislative hearing. But as I have said, if there 

are things that you think we need to do to improve some of the 

things I mentioned before, the way you link environmental hazards 

and health concerns or do things better in the way you operate, we 

would certainly like to you know, get some input in that regard. 

And so I would appreciate your getting back to us. And thank you 

again for all you do. And without objection, the Subcommittee hearing is adjourned. 

[Whereupon, at 11:26 a.m., the Subcommittee was adjourned.] 

[Material submitted for inclusion in the record follows:] 


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Statement of Representative Henry A. Waxman 

Chairman, Energy and Commerce 

Subcommittee on Health 

Hearing on "The Environment and Human Health: 

HHS'Role" 

April 22, 2010 

The profound impact of the environment on human 

health is beyond dispute. This Congress, and this 

committee, have seen many examples of this. Lead paint in 

homes impacts children's development; chemicals in 

drinking water can cause physical harm; and exposure to 

asbestos leads to serious disease. 

We tend to look at these issues one at a time, when a 

concern arises about a particular chemical, food or location. 

But the term "environment" encompasses a vast range of 

spaces in which humans work, live, and develop. 
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Today, we have the opportunity to hear from HHS 

officials who are in charge of researching, tracking, and 

addressing health issues across this broad range. 

Understanding the roles of specific HHS agencies in this 

regard, and how they intersect with and complement the 

roles of other agencies, will leave this subcommittee better 

prepared to consider and address environmental health 

issues in the future. 

Health and the environment have each been priorities 

for me for decades. So I am particularly pleased to spend 

this Earth Day morning looking at the intersection of the 

two. Thank you to Chairman Pallone for holding this 

hearing and to our witnesses for sharing their time and 

expertise with us. 

2 
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Statement of the Honorable Anna G. Eshoo 

Committee on Energy and Commerce, Health Subcommittee 

Hearing on "The Environment and Human Health: HHS' Role" 

April 22, 2010 

Mr. Chainnan: thank you for holding this important hearing on the Department of 

Health and Human Services' role in protecting the health of all Americans. I'm pleased 

we have the NIH and the CDC present here today and I look forward to hearing more 

about their recent work to protect and monitoring public health. 

I'm particularly concerned about the increased reports of the health risks associate 

with bisphenol A, or BPA. The National Toxicology Program and the FDA have 

publicly expressed concerns about the potential effects ofBPA on the brain, behavior, 

and prostate gland in fetuses, infants, and young children. BP A is everywhere- in water 

bottles, canned food, and plastic food packaging. I'm a proud cosponsor of Rep. 

Markey's bill, the Ban Poisonous Additives Act to rid all food containers ofBPA. 

When the House passed the Food Safoty Enhancement Act last year, the 

legislation included a requirement that the FDA evaluate the safety ofBPA and report 

both its findings and plans to address them. While the FDA has reported its concerns 

about BPA, and announced plans to reduce exposure to the chemical, it's critical that the 

FDA has all the tools it needs to accomplish its tasks. I support giving the FDA these 

tools and hope they can be included in the final food safety legislation that's sent to the 

President. 

I'm also interesting in hearing from our witnesses about the issue of safe-disposal 

of unused pharmaceuticals. In my Congressional District, Santa Clara County is 

operating an approved drug "take-back program," though at a considerable expense to the 

County. The cost of operating these programs is discouraging to most localities which, 

unfortunately, can lead to a higher percentage of chemicals in our water supply. 

Expanding these drug take-back programs on a national level could establish national 

standards and provide full or state-matching funds to encourage the safe disposal of 

drugs. 

Thank you, Mr. Chainnan, and I look forward to hearing from our witnesses. 
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Opening Statement 

Honorable Ranking Member Joe Barton 

Subcommittee on Health 

Thursday April 22, 2009 

Mr. Chairman, Webster's Dictionary defines science 

as the, "knowledge or a system of knowledge covering 

general truths or the operation of general laws especially as 

obtained and tested through scientific method." 

Unfortunately, some have decided to distort and 

ignore science in the name of extreme environmentalism to 

enact a dangerous agenda that will increase Americans' 

taxes, reduce job growth and threaten the prosperity of this 

country. They claim theories as facts. Even as they admit 

glaring holes in the data they rely on, they still attempt to 

demonize anyone who dares question their theories. 
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I believe we must take steps to preserve our 

environment for future generations, but it must be done in a 

balanced way taking into account the economic well being 

and national security of this country. Furthermore it must 

be based on sound science. 

Many have spoken about the need to reduce emissions 

into the air. I agree and that is why I have been proponent 

of increasing nuclear power in this country. Nuclear power 

will allow us to diversify our energy portfolio and reduce 

our dependence on foreign sources of energy. At the same 

time it can be done in a clean, environmental sensitive 

manner. Unfortunately, this Administration has announced 

the closing of the Yucca Mountain Nuclear Repository 

which would provide a reliable, secure location to house 

spent nuclear waste. It did so without providing any 
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scientific basis and before the completion of the Nuclear 

Regulatory Commission's safety review. I am interested to 

hear from the witnesses whether their Agencies were 

consulted about the science behind the announced 

shutdown of Yucca Mountain. 

I am actually confounded as to why the Health 

Subcommittee is having a hearing regarding Earth Day but 

the Energy and Environment Subcommittee is not. There is 

so much on the plate of the Health Subcommittee that it 

seems that this Subcommittee's time could be better spent 

addressing pressing health care issues. 

At the end of May, physicians will experience a 21 

percent cut in their Medicare reimbursement rates and face 

future cuts of 5 percent annually. Because the Democrats 
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relied on budget tricks to pass their health care bill, they 

refused to put a long-term fix to this problem in their bill, 

thereby pretending to reduce the deficit. Rather than solve 

the problem, Democrats enact a series of one or two month 

fixes that provide no certainty to doctors treating patients 

around the country. Of course, this Committee has yet to 

hold a hearing on the issue in the last two congresses. 

Every day, more comes out about the health care bill 

and the American people understandably get more upset. 

As Congress has worked to eliminate federal marriage 

penalties, Obama Care actually takes multiple steps 

backwards by disincentivizing people to marry. Yet this 

Committee or any Committee of the House has not held a 

hearing on why it is appropriate in health care legislation to 

penalize marriage. Many Americans did not realize there 
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was a punitive marriage penalty in the so called health care 

reform law, but just like Speaker Pelosi predicted, people 

would have to wait until it was passed until finding out 

what was in it. 

Now the Administration is saying they are going to 

hire a senior level official whose sole duty will be to sell 

the health care bill to the American people before the 

November elections. We have also been told that President 

Obama will be hitting the campaign trail hard to make sure 

that members who voted for the bill are given political 

cover. 

I have an idea. Instead of the hearing last week on 

smokeless tobacco in major league baseball or the hearing 

this week to hear about the duties of the National Institute 
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of Environmental Health Science, Congress could have 

hearings on the 3000 page health care bill that was passed. 

The Committee was unable to ask questions to 

Secretary Sibelius on how she would interpret and 

implement the bill before it was passed. I believe it would 

be a constructive use of our time to have the Secretary 

before the Committee to answer questions on how she 

intends to implement this law that will affect not only every 

citizen today but generations to come. That could be more 

useful than hiring a health care campaign operative at the 

White House or diverting President Obama's attention from 

creating jobs. 

Thank you Mr. Chairman, I yield back the 

balance of my time. 
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QUESTIONS SUBMITTED FOR THE RECORD 

HEARING ENTITLED, 

"THE ENVIRONMENT AND HUMAN HEALTH: THE ROLE OF HHS" 

SUBCOMMITTEE ON HEALTH 

COMMITTEE ON ENERGY AND COMMERCE 

UNITED STATES HOOSE OF REPRESENTATIVES 

APRIL 22, 2010 

Linda Birnbaum, Ph.D., D.A.B.T., A.T.S. 

Director, National Institute of Environmental Health Sciences 

National Institutes of Health 

and Director, National Toxicology Program 

U.S. Department of Health and Human Services 

Questions for the Record 

The Hon. Frank Pallone 

1. As you know, New Jersey is arguably one of the more polluted states in the nation as well as 

one of the most densely populated states. The conditions and environmental health situations 

we are experiencing are most likely very different/rom those that are affecting states that 

have less pollution and a less dense population. 

I am hoping you could explain to the committee how you set your priorities for research. 

How do you at NIEHS balance national priorities with concerns or problems that might be 

more tied to specific areas or regions? 

Response: In setting priorities for research, NIEHS considers several things: scientific 

opportunity (that is, are the scientific tools available to address a question?) scientific merit, and 

public health concern or significance. Public health concern can refer to a national problem or a 

regional/local problem. Often we find that research conducted in areas with specific 

environmental issues yield infonnation that can be used more broadly in policy decisionmaking. 

For example, for a number of years, NIEHS has been funding researchers at Rutgers University 

to study the respiratory effects of ozone exposures associated with air pollution. This is an issue 

that has significant implications for residents of New Jersey, where air pollution resulting from 

industry and transportation is a major health concern. What we've learned from these studies, 

however, also adds to our data for decision making on a national level. The same is true for 

many other environmental agents. Researchers study them where the needs and exposures are 

greatest, but the infonnation we obtain is useful beyond the immediate locality. 

2. In your testimony you talked about some of the very innovative and advanced research your 

agency is working on right now. But could you also provide some insight into where you 

think you might focus your efforts in the coming years? Are there any areas of particular 

interest to the agency? 
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Response: NIEHS is in the midst of a conceptual shift for enviromnental health sciences. We 

can now see a greater level of complexity in how environmental agents make changes in our 

bodies, and we want to understand how these changes are working in the interplay with the 

totality of our enviromnent -- not just chemicals, but nutrition, drugs, infectious disease 

exposures, even stress - how they interact with each other and with our genomes. Complex 

diseases have complex etiologies. The impact of this new understanding will be to give us 

greater opportunities for prevention and for targeted therapeutics. 

Within the framework of this conceptual shift, we can identify priority areas for NIEHS in the 

new era of environmental health sciences. I believe the following will be priority areas in 

enviromnental health sciences for the near future: 

Low Dose: We clearly need to study the effects of toxicants at environmentally relevant doses. 

Windows of Exposure: We need to clearly identify, where possible, exactly when and how 

toxicants are working at susceptible developmental stages in humans, to see if we can trace the 

earliest effects that may lead to complex diseases like obesity, diabetes, and heart disease later in 

life. 

Mixtures: Humans are always exposed to multiple enviromnental agents and it is difficult to 

decipher how exposure to multiple agents will influence the effects of each one. This is an 

ongoing research area for NIEHS. 

Clinical Research: We must take the next step with our basic research and translate our 

knowledge into real, effective interventions in people. 

Emerging Hazards: New problems are discovered all the time, for example, the health issues 

associated with nanotechnology and nanoparticles and with new technologies used to adapt to or 

mitigate climate change. We need to be at the forefront of research in these areas as they 

develop, as we have done with our nanotechnology initiative. 

Human Health Effects of Climate Change: NIEHS needs to broaden its focus on the human 

health effects as well as the clear and substantive improvements for health if we choose the right 

mitigation strategies for reducing greenhonse gas emissions. 

Green Chemistry: NIEHS can help to contribute to this field wherever possible. 

o