Medical Records Could Yield Answers On Fracking

May 16, 2012
Originally published on May 23, 2012 10:50 am

A proposed study of people in northern Pennsylvania could help resolve a national debate about whether the natural gas boom is making people sick.

The study would look at detailed health histories on hundreds of thousands of people who live near the Marcellus Shale, a rock formation in which energy companies have already drilled about 5,000 natural gas wells.

If the study goes forward, it would be the first large-scale, scientifically rigorous assessment of the health effects of gas production.

Secret Weapon: A Very Large Database

In recent years, there have been lots of anecdotal reports about people who say they have been harmed by the chemicals associated with gas wells and the drilling technique known as hydraulic fracturing, or fracking.

But "there doesn't seem to be a lot of hard data to either support or refute those claims," says David Carey, associate chief research officer of the Geisinger Health System, which provides care to more than 2 million Pennsylvanians.

So the Geisinger system wants to use its huge database of electronic health records to help researchers get definitive answers, Carey says.

The long-term goal is to learn whether gas operations increase the incidence of diseases such as diabetes and cancer, Carey says. But first, he says, researchers want to take a quick look at whether air pollutants associated with gas drilling are affecting people with asthma and other lung problems.

The asthma study is possible because Geisinger's database includes tens of thousands of people with asthma, says Dr. Paul Simonelli, the system's director of thoracic medicine.

From his office in Geisinger's gleaming medical center in Danville, Pa., Simonelli demonstrates why the database is so valuable. With just a few computer keystrokes, he brings up the record for an asthma patient.

"This patient's been seen in our system well over a dozen times," he says, scrolling through the record. "And this dates back to 2001."

Looking For Clues In Asthma And Ozone

Researchers want to start with asthma patients because they are very sensitive to ground-level ozone, a pollutant that often forms near gas wells, Simonelli says.

When ozone levels rise, he says, many asthma patients begin to have trouble breathing and seek help.

Primary care physicians are usually the first people patients call, Simonelli says. Then, he says, "we see it in the specialty clinics such as my own, where we'll be messaged by lots of patients that [say,] 'I'm getting worse, what should I do?' "

When ozone levels get really high, he says, asthma patients start showing up in emergency rooms.

About 6 percent of people in the United States have asthma, Simonelli says, "so we're talking about an enormous number of people who are potentially at risk to have their conditions worsened by these exposures."

And the Geisinger database contains such detailed information that it's possible to figure out things like precisely how far each asthma patient lives from a gas well, says Brian Schwartz, an environmental epidemiologist at Johns Hopkins University in Baltimore.

Schwartz, who is working with Geisinger on the project, says the plan is to use air quality data from the Environmental Protection Agency to identify days when ozone levels are high, then use the database to answer a series of questions about asthma patients. Questions such as: "Are they being admitted to the hospital? Are they requiring emergency department visits? Are they using more inhalers?"

'We Just Want The Facts To Lead Us'

Northern Pennsylvania is a particularly good place to ask those questions because gas operations are the primary source of ozone and only began a few years ago, Schwartz says.

"Because we have 10 years of health data, but the drilling has mainly been for the past five years, we have a period with information on asthma patients and controls before drilling, [as well as] a period after drilling," he says.

There's one big hitch, though, Schwartz says. The asthma study alone is likely to cost nearly a million dollars — and no one has offered to pay for it yet.

Even so, Schwartz is optimistic. One reason, he says, is that the research has strong support at Geisinger — from the CEO on down.

There's a good reason for Geisinger's commitment, Carey says. "If you look at the map, the geographic footprint of our patient catchment area, this is literally going on in our backyard."

So Carey and other Geisinger officials have been working to build support for the study among scientists, and capture the interest of funding agencies.

And so far the response has been positive, Carey says, in part because Geisinger is seen as a neutral party in the national debate about fracking and shale gas production.

"We're not out to get anybody," he says. "We just want to let the facts lead us wherever they will. So if we do find that there are environmental exposures that are harming people's health, we'll say it. If we find evidence that there's nothing to worry about, we'll say that, too."

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Transcript

STEVE INSKEEP, HOST:

This week, we're examining the stories of people who live near natural gas wells and are getting sick. We heard stories yesterday of people in Pennsylvania and Colorado. But it takes more than one person's story to make a connection between pollution and illness. Scientists say they want to study detailed information on a large group of people over a long period of time. And there is an effort to do that in the mountains of northern Pennsylvania.

NPR's Jon Hamilton reports.

JON HAMILTON, BYLINE: Energy companies have drilled about 5,000 gas wells in Pennsylvania's Marcellus Shale, and they plan to drill thousands more. So northern Pennsylvania is a pretty good place to ask whether all that drilling is affecting people's health. But researchers say there's another compelling reason to do a study here.

(SOUNDBITE OF TYPING)

HAMILTON: It's a database of electronic health records on hundreds of thousands of people who live near the Marcellus Shale. Without records like this, it would be almost impossible to figure out whether drilling is affecting public health.

DR. PAUL SIMONELLI: So, here, I'm bringing a patient up.

HAMILTON: Dr. Paul Simonelli says those records mean that all kinds of information is just a few keystrokes away.

SIMONELLI: And what is immediately available here is all the office visits this particular patient has had in our system. This patient's been seen in our system well over a dozen times, and this dates back to 2001.

HAMILTON: The database is one of just a handful in the nation that are so large and comprehensive. It belongs to the Geisinger Health System, which includes doctors, hospitals and health insurance plans. Geisinger helps provide care for more than two million Pennsylvanians.

Simonelli is the director of thoracic medicine at the system's gleaming headquarters in Danville. He says eventually, researchers hope to use the database to see whether there's a link between gas drilling and a wide range of diseases, such as cancer and diabetes. But they plan to start by focusing on just one health problem: asthma.

SIMONELLI: This is our pulmonary function lab. So if people were to come in to get pulmonary function testing, this is where they'd be, down this corridor.

HAMILTON: Simonelli says people with asthma and other lung problems are very sensitive to some of the air pollutants that come from natural gas production. He says you can actually measure the effect these pollutants have on an asthma patient's lungs.

MARY ELLEN NORQUEST: I want you to put the mouthpiece in your mouth, between your teeth, lips tight. I'm going to put nose clips on your nose so the air doesn't escape through there.

HAMILTON: A technician named Mary Ellen Norquest shows how.

NORQUEST: And a deep breath in.

(SOUNDBITE OF PATIENT BREATHING DEEPLY)

NORQUEST: Keep pushing. Keep pushing. Push, push, push. Keep pushing. Keep pushing. A couple more seconds.

HAMILTON: Simonelli says the results of tests like this one all end up in the system's database. And that sort of information should make it possible to study the health effects of one pollutant that often forms near gas operations. It's ground-level ozone, or smog. Simonelli says when ozone levels rise, asthma patients start looking for help.

SIMONELLI: The first line of therapy are primary care physicians, and clearly, they'll start seeing more business. We see it in the specialty clinics, such as my own, where we'll be messaged by lots of patients that I'm getting worse, what should I do. People come in the emergency rooms.

About 6 percent of people in the U.S. have asthma. That means Geisinger has records on tens of thousands of asthma patients. And Simonelli says most of these patients live in rural areas, where ozone wasn't a problem before gas drilling.

So we're talking about an enormous number of people who are potentially at risk to have their conditions worsened by these exposures.

HAMILTON: The Geisinger database should be able to reveal any change, because its records go back more than a decade. One scientist who believes in the Geisinger effort is Brian Schwartz, an environmental epidemiologist at Johns Hopkins in Baltimore. He's working with Geisinger on the project. Schwartz says the system's information is so detailed, that it's possible to gather information about specific groups of asthma patients - say, those who live within a mile of a gas well.

DR. BRIAN SCHWARTZ: How much medications they're using, are they being admitted to the hospital, are they requiring emergency department visits, are they using more inhalers.

HAMILTON: Schwartz says Geisinger is in a unique position to measure the effects of a huge natural experiment. That's because in Pennsylvania, large-scale drilling came relatively recently. In places like Texas, most wells were already operating by the time researchers started looking into health effects. And Schwartz says other places don't have Geisinger's trove of electronic health records that go back long before the gas boom started.

SCHWARTZ: Because we have 10 years of health data, but the drilling has mainly been for the past five years, we have a period with information on asthma patients and controls before drilling, a period after drilling. And so I think it's a very powerful design that can answer a number of questions right now.

HAMILTON: There's one big hitch, though. The asthma study alone is likely to cost nearly a million dollars, and no one has offered to pay for it yet. Even so, Schwartz is optimistic. One reason is that the research has strong support at Geisinger, from the CEO on down.

David Carey, who directs the system's Weis Center for Research, says there's a good reason.

DAVID CAREY: If you look at the map, the geographic footprint of our patient catchment area, this is literally going on in our backyard.

HAMILTON: So Carey and other Geisinger officials have been promoting the study to scientists and funding agencies. And Carey says the response has been positive, in part because the health system is seen as a neutral party in the national debate about fracking and shale gas production.

CAREY: We're not out to get anybody. We just want to let the facts lead us wherever they will. So if we do find that there are environmental exposures that are harming people's health, we'll say it. If we find evidence that there's nothing to worry about we'll say that, too.

HAMILTON: Carey hopes to have an answer before a lot more drilling takes place in the Marcellus Shale.

Jon Hamilton, NPR News.

INSKEEP: Our series continues this afternoon on ALL THINGS CONSIDERED, with the story of a Texas town at the center of the fracking boom. Transcript provided by NPR, Copyright NPR.