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Six years after the World Trade Center collapsed on Sept. 11, 2001, doctors dedicated to studying the health effects on rescue and recovery workers are just beginning to learn exactly what workers were exposed to while sifting through the rubble of the Twin Towers.

It is exposure to the mix--of asbestos, dioxins, kerosene, industrial lubricants and other carcinogens--that has experts like Dr. Robin Herbert worried.

No one who worked on "the Pile" is immune. A May article in the New England Journal of Medicine, for example, described tiny particles of dust and gases as the vehicle of transmission of the toxins from the air into the human bloodstream.

Researchers now theorize there are three waves of conditions overcoming the WTC responders.

The first wave is loss of lung function marked initially by the symptom called World Trade Center cough. Herbert said that she could pick out in her waiting room who was a responder by the presence of this symptom.

The cough has subsided, but the result, in the words of researchers, is "substantial and probably permanent loss of lung function ... as severe as 10 times the loss predicted for a single year of aging."

As part of this first wave, Herbert, interviewed by the New England Journal of Medicine, says, "We are now seeing an asthma-like problem, probably due to the alkalinity of the dust."

A second wave is emerging, the experts say. They call it interstitial lung disease. Its victims suffer from lung inflammation. The lung stiffens and becomes permanently scarred. Eventually, the lung tissue loses its ability to carry oxygen, and breathing becomes labored.

But even worse may be yet to come.

"We are worried about a third wave," Herbert says, "which is cancer down the road." Cancer may not develop for decades, but clinicians are nevertheless on the lookout for leukemias and lymphomas.

They worry about a handful of cases of multiple myeloma among young responders, a condition which typically develops during middle age.

And rare conditions are cropping up. "One of the things that surprised me is often we are seeing the so-called 'zebras' that we've never seen before," says Herbert, referring to conditions rarely seen, or only studied through medical school text books.

Doctors and researchers knew from the morning of Sept. 11 that they were going to have to be hypervigilant in monitoring responders, but only now is the scope of the Sept. 11 health effects emerging.

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September 1, 2007

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