Science requires replication, and lots of it.
So it’s been difficult to gauge the health impacts of shale development from a few scattered studies, says Bernard Goldstein, a public health expert who once led the University of Pittsburgh’s Graduate School of Public Health and remains an active voice in the fracking health debate.
What’s more, it’s been difficult to get such studies funded, he said, although interest and money for research is increasing.
"There is much more enthusiasm to fund these kinds of studies now than there was before Obama got re-elected," Dr. Goldstein said.
Public health concerns with fracking have intensified in recent weeks, although the issue has been bubbling for years in Pennsylvania.
Earlier this month, half a dozen environmental groups called for an official investigation into the state health department's handling of complaints related to oil and gas development.
The groups, including PennFuture, PennEnvironment and the Sierra Club, said they had been provoked by news accounts revealing that the Department of Health had a list of “buzzwords" relating to Marcellus Shale activities that, if said by callers, would mean their complaints would be handled differently than other complaints.
And former Secretary of the Pennsylvania Department of Health Eli Avila was quoted saying the state did not study the potential health impacts of shale gas exploration.
Mr. Avila, who resigned in 2012, now heads the Orange County Department of Health in New York State, where shale drilling is under a moratorium. In an interview with the Associated Press earlier this month, he said the Pennsylvania legislature yanked $2 million in funding for a statewide health registry that was proposed by the governor's own Marcellus Shale Commission.
Dr. Goldstein, who is listed as a member of the Marcellus Shale Commission's health and environment working group, says no such group was actually convened. Instead, faced with criticism that the commission failed to include public health experts, the commission came up with the idea of a statewide health registry. Mr. Goldstein approved of it.
But, as Mr. Avila noted, it was never funded.
Allegheny County takes the lead
"I like to think that was all in another state," said Bruce Pitt, chair of the University of Pittsburgh's Department of Environmental and Occupational Health, who has overseen several studies exploring links between health and Marcellus Shale development.
What’s comforting to him is that the Allegheny County Health Department seems to be approaching the issue with forethought.
In April, the department hired LuAnn Brink, a former assistant professor at Pitt, to lead its epidemiology division.
Ms. Brink was one of the researchers at the university looking into the pregnancy outcomes for women living near well sites.
She declined to talk about her study as it is being prepared for publication now.
Ms. Brink said she would like to see some kind of health registry for fracking complaints and "we would hope that would be at the state level."
But locally, Ms. Brink said the county health department will investigate any health complaint that comes in, focusing specifically on "clusters of illness around drill sites."
So far, she's not aware of any such calls.
People who think they may have been sickened by nearby oil and gas operations typically complain of headaches, nosebleeds, lesions, nausea, and dizziness.
"These issues are pretty nonspecific," Ms. Brink said. "There's no really definitive health outcome or issue that's been associated with it at this point."
A 2013 study from the University of Pittsburgh showed that the most common health outcome from exposure to shale gas activity is stress.
"We're really keeping a very close eye on what's going on in the published literature to just maintain awareness of the potential health effects, and, to that end, we are being pretty proactive in our air monitoring around the fracking sites, especially ones that are coming up," Ms. Brink said.
"We just believe that it's very important to monitor the air before drilling commences and through every phase of the operation — drilling, fracking, flowback, and of course while they're extracting the natural gas."
Ms. Brink said the health department also will work with the state Department of Environmental Protection to get water samples at Deer Lakes Park before and after drilling begins.
Also, the health department is currently compiling a list of government and peer reviewed studies chronicling what is currently known about drilling health impacts which will be posted on the agency’s website sometime next month, Ms. Brink said.
Mr. Pitt said it's comforting to have someone like Ms. Brink at the health department of a county about to embark on two major drilling projects.
"We’re familiar with her skills and looking forward to a closer interaction," he said. "We're lucky in Pittsburgh."
So far, several studies have focused on the impacts of shale gas exploration on pregnancy outcomes.
A study out of Colorado published in April in the journal of Environmental Health Perspectives drew a link between a pregnant woman's distance from oil and gas wells and the increased prevalence of congenital heart defects. The study used publicly available data — Colorado's well location database and the state's birth records registry — for its analysis, which also found that babies born to mothers living near well sites were slightly less likely to be born early or have low birth weight.
Ms. Brink’s study in Pittsburgh looked at birth records from Pennsylvania to explore similar inferences.
So far, studies have relied only on the location of a well to establish links to health outcomes. But Brian Schwartz, co-director of the program on global sustainability and health at the Johns Hopkins Bloomberg School of Public Health, is breaking down exposures by what's happening on those well sites.
"We're going to really look at health outcomes by the phase of well drilling and stimulation," Dr. Schwartz.
Knowing the date a well was spud, or when construction began, could be a clue for estimating truck traffic. Knowing the frack date corresponds to diesel pollution and possible hydrocarbon emissions. The team of researchers on the project are also mapping the location and capacity of compressor stations, using paper records from DEP regional offices.
Dr. Schwartz is involved in a series of studies at Geisinger Health System, a mostly rural network in northeastern and central Pennsylvania that serves about 3 million people. Geisinger has the advantage of pulling detailed patient data from its electronic medical records.
Dr. Schwartz is overseeing two studies at the moment: One will measure pregnancy outcomes for women living in proximity of a well site. The other will look at medical events for 38,000 asthma patients, assessing how many times they were hospitalized, if their medication regimens intensified and if their asthma was under control at critical periods in the shale gas development process.
The first round of results will be ready within the next year, Dr. Schwartz said.
"I think we’re taking a much more careful approach to exposure," he said. "The one thing we’re not doing is we’re not measuring anything new. But don’t forget, most of our health outcomes happen in the past."
In theory, findings from the Geisinger studies could be generalized to other areas in Pennsylvania, although different drilling conditions may elicit different responses.
Last year, a group of stakeholders convened by the University of Pittsburgh's Institute of Politics recommended establishing a fund for health and environmental research, something akin to what the Health Effects Institute in Boston has been doing for the past 34 years.
The Boston institute gets half its money from the Environmental Protection Agency and half from the auto industry and doles it out to scientists doing research into the air pollution impacts of cars.
The organization is branching out into shale research and held its first meeting in Pittsburgh in June. By the end of the year, Dan Greenbaum, president of the institute, hopes to have an assessment completed of existing research studies and gaps in research that could and should be addressed.
"Some people feel that, gee, we already have a lot of this. Why are we doing research?" Mr. Greenbaum said.
Indeed, more than 7,000 unconventional wells have already been drilled in Pennsylvania. But if industry estimates pan out, there might be more than 60,000 wells on the ground in the future.
"Sometimes you have to take the long-term view here," he said.
That's not to say even preliminary research can't have immediate impacts on industrial operations and regulations. In fact, it often does.
"You usually need a couple of ways of looking at this," Mr. Greenbaum said. "Very often, the most knowledge you can get about cause and effect is [from] smaller studies, smaller geographic areas."
That points researchers in a certain directions and develops testable hypotheses for broader studies.
"Health tracking is not a panacea,” said his colleague Bob O’Keefe, who is vice president at the Health Effects Institute. “It's one of a number of tools.”
Anya Litvak: firstname.lastname@example.org or 412-263-1455