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7.
Michael R. Edelstein,
Contaminated Communities: Coping with Residential Toxic Exposure
(Westview Press, 2004), ch. 4.

8.
Nancy Lorenzo, quoted in Mark Fritz, “Little League Giants Put Town on Map, For Good,”
Los Angeles Times
, August 31, 1998.

9.
The second and third quotations are from Laurie Baiamonte Amato and Kevin Turner in Nichole M. Christian, “What Tropical Storm? Only Bliss in Toms River,”
New York Times
, August 29, 1998.

10.
Eugene Gessler, Ciba Toms River site manager, quoted in Jean Mikle, “Cancer Death Rate Normal among Ex-Ciba Workers,”
Asbury Park Press
, July 2, 1998.

11.
Nalini Sathiakumar and Elizabeth Delzell, “An Updated Mortality Study of Workers at a Dye and Resin Manufacturing Plant,”
Journal of Occupational and Environmental Medicine
42:7 (July 2000): 762–71.

12.
Sathiakumar and Delzell, “Updated Mortality Study,” 762.

13.
Delzell, Macaluso, and Cole, “Follow-Up Study of Workers,” 276–77. See also Barbone,
Nested Case-Control Study
, 39–40.

14.
Jean Mikle, “Third Toms River Well Has Traces of Pollutants,”
Asbury Park Press
, September 10, 1998.

15.
John Jenks et al.,
Characterization of Non-Target Substances in the Ground-water near the Reich Farm Superfund Site, Dover Township, New Jersey
, New Jersey Department of Environmental Protection (April 10, 2000), 5.

Chapter Twenty-One

1.
For a list of Paracelsus’s attributed works, see Franz Hartmann,
Life and Doctrines of Philippus, Theophrastus Bombast of Hohenheim Known as Paracelsus
(Kessinger, 1992), 31–36.

2.
The quotation, “Alle Ding sind Gift und nichts ohn Gift; allein die Dosis macht, das ein Ding kein Gift ist,” appears in Paracelsus’s
Seven Defensiones
, first published in 1538. See
Four Treatises of Theophrastus Von Hohenheim, Called Paracelsus
, 22.

3.
Laura N. Vandenberg et al., “Hormones and Endocrine-Disrupting Chemicals: Low-Dose Effects and Nonmonotonic Dose Responses,”
Endocrine Reviews
33:3 (June 1, 2012): 378–455. See also Dan Fagin, “Toxicology: The Learning Curve,”
Nature
490:7421 (October 25, 2012): 462–65.

4.
Morris Maslia faced many other complications, too, in constructing the water model for Toms River. The old records of the Toms River Water Company were sparse, and he could not conduct a real-world tracer test to confirm the accuracy of his model. In Woburn, Peter Murphy had arranged to add a fluoride tracer to each well, one at a time, and then collect water samples all over town to see if each well’s water was distributed as the model predicted. But after the trauma Toms River had been through since 1996, no one wanted to seek permission to add anything to the water system—even table salt, which Maslia considered using as a tracer. Fortunately, during the emergency water tests of 1996, Jerry Fagliano had noticed that concentrations of naturally occurring barium varied significantly from well to well and thus could serve as a natural tracer Maslia could use to verify his model.

5.
New Jersey Department of Health and Senior Services,
Public Health Assessment: Reich Farm
and
Public Health Assessment: Ciba-Geigy Corporation
(March 12, 2001). Said Bruce Molholt, whose work experience included four years at the EPA: “I’ve seen at least one hundred, maybe two hundred of these health consultations, and they never find anything. I was astounded when ATSDR came right out and said we do find reason to believe there was harm caused by both air and water contamination.”

6.
U.S. Environmental Protection Agency,
Final Source Control Remedial Investigation Report: Ciba-Geigy Site, Volume 4
(December 1994).

7.
William P. Eckel, Disposal Safety Incorporated,
Tentatively Identified Compounds at Ciba-Geigy Site, Toms River, NJ
(May 28, 1997), 4. This report was produced by a consultant hired by the Ocean County Citizens for Clean Water, funded by Ciba to provide independent oversight of the factory cleanup.

8.
Radiation is the only conclusively proven environmental risk factor for pediatric leukemia and nervous system cancers. For more about risk factors, see National Cancer Institute Cancer Statistics Branch,
Cancer Incidence and Survival Among Children and Adolescents: United States SEER Program, 1975–1995
(1999).

9.
The azo dye ingredient benzidine, for example, was not just a bladder carcinogen; it also caused nervous system cancers in mice. Acrylonitrile was one of the few chemicals known to cause brain tumors in rats, and factory studies suggested that it might cause brain cancer in humans, too, although there was conflicting evidence. Other research found that parents exposed to nitrobenzene were more likely to have children with brain cancer and that parental exposure to TCE and benzene raised the risk of childhood leukemia.

10.
National Toxicology Program,
Draft NTP Technical Report on the Toxicology and Carcinogenesis Study of Styrene-Acrylonitrile Trimer in F344/N Rats
(December 2010), 22–24.

11.
James Huff, “Long-Term Chemical Carcinogenesis Bioassays Predict Human Cancer Hazards: Issues, Controversies, and Uncertainties,”
Annals of the New York Academy of Sciences
895 (December 1989): 56–79.

12.
To be placed into the National Toxicology Program’s highest category (“clear evidence” of carcinogenicity in animals), a compound generally needed to
cause tumors in multiple organs or in both mice and rats. Only about 25 percent of chemicals tested by the NTP met this higher standard. See Victor A. Fung et al., “Predictive Strategies for Selecting 379 NCI/NTP Chemicals Evaluated for Carcinogenic Potential: Scientific and Public Health Impact,”
Fundamental and Applied Toxicology
20 (1993): 413–36.

13.
In 1999, the National Toxicology Program was just completing a study of acrylonitrile that would find “clear evidence” that it caused cancer in mice. See National Toxicology Program,
NTP Technical Report on the Toxicology and Carcinogenesis Studies of Acrylonitrile in B6C3F1 Mice (Gavage Studies)
, Report TR-506 (October 2001).

14.
D. J. Caldwell, “Review of Mononuclear Cell Leukemia in F-344 Rat Bioassays and Its Significance to Human Cancer Risk: A Case Study Using Alkyl Phthalates,”
Regulatory Toxicology and Pharmacology
30:1 (August 1999): 45–53.

15.
Only a few chemicals had ever been found to trigger brain tumors in rats, but one was acrylonitrile, one of SAN trimer’s two ingredients, in a test involving Fisher 344 rats. See D. D. Bigner et al., “Primary Brain Tumors in Fischer 344 Rats Chronically Exposed to Acrylonitrile in Their Drinking Water,”
Food and Chemical Toxicology
24:2 (1986): 129–37.

16.
There was one fewer control family than planned, because one had been chosen errantly.

17.
One of the only truly bizarre results from the Toms River interview study, almost certainly attributable to chance, was that children with brain cancer were 70 percent
less
likely to have been born to mothers who ate cured meat at least once a week during pregnancy, compared to mothers who followed their doctors’ advice and avoided foods that were high in sodium and nitrates. See New Jersey Department of Health and Senior Services,
Case-Control Study of Childhood Cancers in Dover Township (Ocean County), New Jersey. Volume III: Technical Report Tables and Figures
(January 2003), 14, table 34.

18.
Childhood Cancers in Dover Township (Ocean County), New Jersey. Volume III: Technical Report Tables and Figures
, 1–6, table 34.

19.
In addition to Ciba, the class-action lawsuit,
Kramer et al. vs. Ciba-Geigy et al
. also named United Water and the two former Ciba employees who pleaded guilty to illegal dumping back in 1992, James McPherson and William Bobsein, as defendants. The lawsuit was resolved in August of 2002 without any admission of liability and with modest but undisclosed payments to the injured adults. For the uninjured, the companies agreed only to pay for ten years’ worth of screening for bladder cancer. Anyone who had drunk Toms River water in 1965 and 1966 was eligible. The settlement was the closest Ciba and United Water would ever come to acknowledging that their predecessors, Toms River Chemical and Toms River Water, had kept the public in the dark in 1965 and 1966 when dye chemicals seeped into the riverside wells on Holly Street and then into the homes of thousands of water customers in Oak Ridge and elsewhere. See Ana Alaya, “Toms River Families Press Fight,”
Star-Ledger
, December 18, 2002.

20.
The property-damage class-action lawsuit,
Janes et al. vs. Ciba-Geigy Corp. et al.
, stagnated in the court system for more than ten years before it was finally resolved
in June of 2011. Under the terms of the court-approved settlement, Oak Ridge homeowners who bought their homes before March of 2000 and sold them before 2009 were awarded $4,000 each (up to a total of $900,000). Ciba also agreed to create a permanent, sixteen-acre buffer zone on the southeastern edge of the property (abutting homes along Cardinal Drive) and to spend $25,000 to landscape the buffer. By far the largest cash payment went to the plaintiffs’ attorneys; Ciba agreed to pay them $3 million.

21.
For a mid-1990s overview of the progress and potential of molecular epidemiology, see Frederica P. Perera, “Molecular Epidemiology: Insights into Cancer Susceptibility, Risk Assessment, and Prevention,”
Journal of the National Cancer Institute
88:8 (April 17, 1996): 496–509; and Frederica P. Perera et al., “Molecular Epidemiology in Environmental Carcinogenesis,”
Environmental Health Perspectives
104, Supp. 3 (May 1996): 441–43.

Chapter Twenty-Two

1.
B. A. Finette et al., “Gene Mutations with Characteristic Deletions in Cord Blood T Lymphocytes Associated with Passive Maternal Exposure to Tobacco Smoke,”
Nature Medicine
4:10 (October 1998): 1144–51.

2.
In an email to the author, Jack Mandel wrote that he “has no recollection of this discussion with Clapp. I can’t believe I would have said something like this.” For his part, Richard Clapp says he is certain that Mandel made the remark: “I’ll never forget it.”

3.
For detailed accounts of how the water model was constructed, see Morris Maslia et al.,
Historical Reconstruction of the Water-Distribution System Serving the Dover Township Area, New Jersey: January 1962–December 1996
(Agency for Toxic Substances and Disease Registry, 2001), and also Morris Maslia et al.,
Analysis of the 1998 Water-Distribution System Serving the Dover Township Area, New Jersey: Field-Data Collection Activities and Water-Distribution System Modeling
(Agency for Toxic Substances and Disease Registry, 2000).

4.
Because there was so much uncertainty about when pollution from Reich Farm first reached the Parkway wells, the state’s case-control studies also included exposure scenarios that started as early as 1978 or as late as 1986, although the health department considered 1982 to be the best guess of when the first contamination occurred. In any case, moving the exposure window forward or back a few years did not materially change the results of the case-control studies (odds ratios were highest for a 1984 start date). For the Holly well contamination, which was assumed to have ended by 1975, the state also tested an alternate scenario in which the contamination did not end until 1980. Again, there was little change in the study results.

5.
To quantify exposure to contamination from private wells, the state identified eleven neighborhoods where private wells had been contaminated by industrial chemicals, including Pleasant Plains and Oak Ridge Estates. A mother or child who lived in one of those eleven areas and relied on a private well during the months and years before diagnosis would be classified as highly exposed.

6.
State cancer registries were crucial to identifying the forty-eight case children in the birth record study. Investigators looked for name and birth date matches
between Toms River birth certificates and registries in New Jersey and nine other states. They then identified cancer-free children for the control group by looking for birth certificates that matched case children, in groups of ten, by age and sex.

7.
Since they had no information about the birth record study children other than their birth certificate and diagnosis, investigators had to make two assumptions in order to estimate a mother’s exposure to contaminated air and water during pregnancy: first, that she had not changed addresses while pregnant and, second, that if she lived near a water line, she got her water from the public supply system, not from a backyard well or from bottled water.

8.
To avoid potentially biasing his calculations, Morris Maslia did not know which addresses were for children with cancer and which were for healthy controls. He also did not know which months during the study period were relevant for each child.

9.
A prenatal water exposure score of 50 percent or higher was classified as high, less than 10 percent was low, and everything in between was medium.

10.
Twenty-five case children in the interview study were also in the birth record study, but the overlap was limited because the two studies defined cases differently. The interview study cases included only children diagnosed with leukemia, brain or nervous system cancers (the birth record study included any form of childhood cancer), and only children who lived in Toms River at the time of diagnosis (the birth record study included children who had moved away). In one way, the interview study was more inclusive: It included some children who were not born in Toms River, while the birth record study, based on birth certificates, included only natives.

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