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Of the 9,442 responders tested between July 2002 and April 2004, 69 percent reported new or worsened respiratory symptoms after being involved in WTC work, the study found. The symptoms persisted in 59 percent of those workers. And 61 percent of the workers without prior symptoms developed breathing troubles after 9/11.
One in four had abnormal breathing-test results. Among nonsmokers, 27 percent had abnormal results, compared with 13 percent in the general population. The prevalence of low lung capacity among nonsmokers was five times greater than in the general U.S. population.
"There should no longer be any doubt about the health effects of the World Trade Center. Our patients are sick," says Dr. Robin Herbert, co-director of the Mount Sinai program.
Phillip Landrigan, one of the study's authors, says that the caustic dust caused burning and scarring in the lungs, leading to the shrinking of tissues and "functional abnormalities."
"There is a high likelihood that a lot of this impairment is going to be permanent," says Landrigan.
The authors of the study proposed that WTC workers should be tracked for "at least 20 to 30 years." About 6,500 people are being treated in Mount Sinai and other hospitals by a federally funded consortium.
The authors acknowledge limitations in the study, the chief one being that they did not have preSeptember 11 clinical data. And they note that the sicker responders were more likely to sign up for the clinic, which could skew the percentages.
Officials with the city's health department have also attempted to describe the array of illnesses cropping up in the WTC population.
In March, city health commissioner Thomas Frieden wrote an article in which he listed persistent mental-health ailments and mild to severe respiratory problems. Some people found that pre-existing conditions like asthma got worse, he wrote; others developed new symptoms or illnesses. People who were caught in the dust cloud had the highest risk of exposure.
But Frieden said the exact number of people who developed severe respiratory illness is still unknown. Also unknown is how many people have respiratory symptoms today, which illnesses are most common, and what factors other than dust-cloud exposure contributed to those illnesses.
The Frieden article came six months after the health department finally issued guidelines for doctors that listed 12 "potentially WTC associated conditions," including asthma, heartburn, throat irritation, acid reflux, and shortness of breath. More serious illnesses, such as interstitial lung disease, chronic bronchitis, and pneumonia, were listed as "currently under evaluation"in other words, not necessarily related to the dust. The document also includes a giant disclaimer: "The physical health problems discussed in this publication are common and may not be WTC-related even among persons exposed to the disaster."
Kathy Burns, a Massachusetts-based toxicologist, says the guidelines should have been released much sooner.
"An awful lot of the patients were repeatedly misdiagnosed, partly because there wasn't an awful lot of information being put out by the state or the city," Burns says. The DOH guidelines, she adds, came "way too late. . . . And it covered only a small subset of what in the long run will be a problem."
Other advocates say that the reason more isn't known about these WTC-related ailments today is that the Bush administration acted too slowly, or even resisted funding research and monitoring programs.
"The main reason we don't have more information is that the federal government hasn't done the research," Maloney says. "The answer is not unknowable."
When it comes to cancer, obtaining the data that will either establish or disprove a link with toxic WTC dust is still years away, researchers say. But that hasn't stopped advocates from pressing the point that the dust has already caused the disease to show up in responders.
David Worby, the lead attorney in the class-action lawsuit, has said in the Voice that among his 10,000 clients are at least 400 cancer casesa fact, he asserts, that demonstrates a clear link between the dust cloud and cancer. A series of other media reports have also made that connection.
The theory goes that the unprecedented toxic mixture of chemicals in the dust weakened the immune systems of Ground Zero workers to the point that they have become far more susceptible to serious illnessespecially if they'd been exposed to toxins earlier in their lives.
In particular, dozens of cases of blood-cell cancerslike lymphoma and multiple myelomaamong relatively young Ground Zero workers have raised these concerns. Herbert, the Mount Sinai researcher, was quoted as suggesting that such cancers could become a "third wave" of ailments.
"Doctors have told me that this cocktail of poison could very well cause cancer," says Representative Carolyn Maloney, who has become a leading advocate on the issue.
For the families of Ground Zero responders, the link with cancer is very real and deeply troubling. Just ask Michelle Shore, whose husband Robert, a city correction officer who worked at Ground Zero, died of pancreatic cancer in August 2005.
Shore did have heart problems, but otherwise he was fine, his wife says. "He was a healthy man, but he was misdiagnosed and forced into retirement. Now I've lost my houseeverythingand I'm living with my parents. We're all struggling."