Every medical student learns this much Latin: primum non nocere: “First, do no harm.”
For centuries, all newly minted physicians have taken the Hippocratic Oath before treating any patients. This central tenet dictates that a practitioner follow two mandates: to strive to do good, or at least do no harm.
It appears to some scientists, politicians and residents that Colorado’s top medical officials, tasked with protecting residents’ health, never received the memo.
Many residents on the Front Range fear that the Colorado Department of Public Health and Environment (CDPHE), especially Dr. Larry Wolk, the department’s executive director and chief medical officer, are violating this fundamental pillar of the medical profession when it comes to protecting the public from the known and potential health impacts of oil and gas development. Some scientists who study air emissions and health impacts associated with living near unconventional oil and gas operations also question whether the health department is following basic principles of scientific integrity.
A recent case in point highlights both concerns. In February, the CDPHE released a controversial report, which concluded that the risk of harmful health effects is low for people living at least 500 feet from oil and gas activities. It said that concentrations of some substances, including benzene, a well-known carcinogen, were four to five times lower than standard health limits set for short- and long-distance exposure. In its report, which combined a health-risk assessment and a review of 12 previous epidemiological studies, the health department did not recommend immediate public health measures. Rather, it called for more research. Industry advocates and their political allies quickly seized on the study and trumpeted that it proved that oil and gas development was safe to Colorado residents.
Some state legislators have criticized the CDPHE and especially Dr. Wolk for not putting the health and safety of patients, namely citizens, first. “Their (CDPHE’s) job is to protect our health,” said Sen. Matt Jones (D-Boulder), in a phone interview. “A physician knows to ‘do no harm,’ but this study was pretty cavalier.” He added, “I don’t think they’re following the precautionary principle or the ‘do no harm’ edict.”
CDPHE director Wolk took offense to such charges. “I think it’s completely unfair,” he said in a phone interview. “It’s putting something like the Hippocratic Oath, which I take very seriously, in a political context. And it attacks what I think is credible science that we try to objectively present.”
Wolk is a pediatrician who continues to see patients, most of them uninsured, in his nonprofit clinic practice. “That’s why I get further bruised when somebody tries to question my morals and my obligation to the Hippocratic Oath as a physician, because it’s something I hold near and dear to my heart.”
Still, several public health researchers as well as atmospheric scientists working on air-pollution studies argue that a growing body of research suggests the CDPHE is seriously underestimating actual health risks. At a recent science forum in Boulder, Frank Flocke, an atmospheric chemist at the National Center for Atmospheric Research (NCAR), presented much-anticipated preliminary results from research conducted with NCAR colleague Gabriele Pfister and other institutions. The research team discovered that levels of the carcinogen benzene, which is released as a by-product of oil and gas production, sometimes spiked to levels that neither he nor the Environmental Protection Agency (EPA) would consider to be safe for nearby humans. Murmurs erupted in the packed conference room when Flocke said he would not live near high-density oil and gas wells in Weld County.
“I’d move away if I lived anywhere near there, and as quickly as possible,” he said. One canister sample drawn from a mobile van near Platteville, a small town in Weld County, showed benzene concentrations as high as 120 parts per billion, or ppb. (There is no safe level of benzene, not even 1 part per billion (ppb), according to the EPA). Many times measurements at a fixed monitoring station in Platteville showed concentrations above 1 ppb.
The timing of the CDPHE report’s release, less than two weeks after publication of a more alarming health study, also raised some eyebrows. That study, led by Lisa McKenzie, a researcher at the Colorado School of Public Health Anschutz Medical Campus, found that children suffering from acute lymphocytic leukemia (ALL), the most common childhood cancer, were more than four times more likely to be living in areas with the highest density of gas wells. “We were a little surprised at the size of the association — four times higher,” said McKenzie, in an interview in her office.
McKenzie’s paper was peer-reviewed. That means that other researchers not involved in the paper critiqued its methods and conclusions before it was published. By contrast, CDPHE’s report was not peer-reviewed, which in the scientific world makes it a little like playing an NBA playoff game without any referees.
“In the scientific world, when we do a study we don’t talk about it or release the results until we have it published in the peer-reviewed literature,” McKenzie said. “Peer review is a rigorous process.”
The discrepancy between these two studies’ methods and conclusions points to broader questions that gnaw at the minds of scientists and Colorado residents like thistle clinging to a hiker’s sock: Just how safe is it to place tens of thousands of oil and gas wells in proximity to the places people live? Are there negative health impacts from the toxic emissions that are released into the air that millions of people breathe? Who is monitoring and tracking these impacts? Many scientists, including some who attended the recent science forum, are urging the state health and environment officials to listen more to scientists and draw on their expertise.
Addressing members of the CDPHE’s Air Quality Control Commission at the recent science forum, which was hosted by the commission, Gabrielle Pétron, an atmospheric scientist at NOAA, said this: “You are in charge of helping all actors here in Colorado maintain the beautiful state that we live in.”
Pétron has conducted studies that show how methane and ozone emissions in western Colorado and on the Front Range have an identical chemical signature to oil and gas activities rather than other potential sources. Her findings also include measuring much higher levels of benzene than regulators had estimated. “What are the big questions you’d like to have answered to guide your decision-making in protecting people’s health and the environment with adequate regulation?” Pétron asked the health department commissioners. “We scientists like to contribute to well-informed decision-making.”
Public health concerns have taken on more urgency in the wake of the April 17 pipeline explosion of a home in Firestone that killed two men and injured a woman and her child, and after Boulder County’s five-year moratorium on hydraulic fracturing, or fracking, ended on May 1. A surging population on the Front Range is colliding with the rapid expansion of unconventional oil and natural gas development, with some permitted sites having as many as 40 wells on them within 500 feet of homes, playgrounds and water sources. The state requires that oil and gas wells be at least 500 feet away from homes, and 1,000 feet from schools, hospitals, jails and other multiple-occupancy buildings. But operators can file for special permission from the Colorado Oil and Gas Conservation Commission (COGCC) to be closer, and they are rarely turned down. In addition, the setback rules don’t apply to developers who can build homes right next to existing wells, as happened in Firestone.
The state’s top health officials have not questioned the appropriateness of the setback regs of the COGCC, on which CDPHE’s Wolk is a commissioner. “I think we can say that, based on the data we have right now, the risk appears to be low,” said Mike Van Dyke, the state’s chief environmental epidemiologist who led the CDPHE’s health assessment in an interview. He was speaking in reference to health risks, not acute safety risks such as what occurred in the Firestone explosion.
But even the atmospheric scientist whose research the CDPHE is drawing on for a health-risk assessment that it is currently conducting, questions the logic. “Right now, setback distances are not based on a lot of scientific information, because we haven’t had it,” Jeffrey Collett, head of Colorado State University’s Atmospheric Sciences Department, said in an interview at the science forum.
Living near oil and gas activities will become an inevitable reality for thousands more residents if current trends continue. And this conflict will likely expand even faster if the price of oil continues to rebound. The COGCC regulates the permitting of wells and investigates leaks, but does nothing to monitor emissions and public health impacts. That is the job of the CDPHE. With so many questions swirling about its methods and conclusions, many around the state are questioning whether they can trust that state health officials are doing their best to ensure public health and safety.
Other states have already pressed the pause button in response to the growing body of scientific evidence pointing to both health and environmental concerns. New York and Maryland, for instance, have banned fracking. Several countries, including France, Bulgaria and Scotland, also have banned the practice. More than 700 peer-reviewed papers worldwide, most of them published in the last four years, show evidence that fracking and horizontal drilling have environmental and human health impacts, ranging from contamination of groundwater to increased prevalence of asthma, cancer and mental health problems.
Fractured bodies and communities
Lauren Bouche doesn’t need an epidemiologist to tell her that oil and gas operations are threatening human health. She woke up one morning seven years ago gasping for breath in her ranch home on a sleepy dirt road on the edge of Brighton in Weld County. She had experienced mild seasonal allergies over the years, but nothing like this. Bouche, 71, went to her doctor, who diagnosed her with asthma. The doctor told her that many other patients who live near oil and gas wells are also being treated at the clinic for asthma. Bouche started taking a steroid inhaler twice a day to quell the symptoms. At the time of her asthma diagnosis, much of Weld County’s landscape, beyond three miles of Bouche’s home, already looked like a checkerboard of farms, well sites and housing developments.
Bouche, a Denver native, and her husband, Jack Hauser, moved to this rural neighborhood 31 years ago. They were drawn to its quiet, pastoral landscape and the big-sky view of the Continental Divide. Her neighbors still include Angus cattle and horses that spend their days munching in grassy meadows, oblivious to the seismic shift in the fields around them.
About five years ago the natural gas boom moved in much closer. Diesel trucks started rumbling down nearby streets, kicking up dust in their wake. Soon thereafter drill rigs popped up, their red lights flashing through the night, followed by the periodic roar of helicopters delivering parts, then the steady engine hum of drilling, and then fracking. Now, the Bouches live within a quarter mile of two six-well sites, both in production mode. Another half mile to the north, beyond a stretch of prairie grass, sits a sprawling 21-well site, operated by Great Western Oil and Gas. Ironically, it butts up against one of the largest wind-energy manufacturing plants in the United States. Denmark-based Vestas makes blades and other parts for wind turbines there.
Bouche squarely blames toxic emissions from oil and gas activities for her asthma. “I’m sure, but I can’t prove it,” she said. Two to three years ago she started suffering from another ailment, sinus inflammation, which she attributes to nearby oil and gas emissions.
“I can’t describe how painful it is sometimes — like battery acid in my sinuses,” Bouche said.
Staring out of piercing blue eyes, her reddish bob hairdo and multi-colored Inkkas sneakers framing her fiery exasperation, Bouche rested on a yellow couch in her living room after giving me a tour of the dozens of existing and planned well sites within two miles of her home.
In January, Hauser was diagnosed with lung cancer. As he shuffled into the kitchen, wearing sagging jeans and a wool cap to hide the chemotherapy effects, Bouche said she couldn’t help but wonder if living near wells is at least partly to blame, given that he quit smoking 25 years ago.
Proving that Bouche’s asthma and sinus inflammation, or her husband’s cancer stem from oil and gas development is a difficult task. Epidemiology, the science that explores the spread of disease, can rarely pinpoint a specific patient’s illness to a single source. McKenzie’s leukemia study is one step along this path of proving “causality,” but this kind of research takes time and money. McKenzie’s study, based on data from the CDPHE’s cancer registry, was not actually designed to explore or prove a causal link. It showed only a link between the distance from oil and gas wells and increased risk of childhood leukemia. McKenzie cautiously stressed in her study that more research is needed to determine if living near oil and gas wells causes or contributes to cancer or other health problems.
Nonetheless, among the attacks on her by the oil and gas industry and its proxies were claims that she did not prove a causal link and that her findings were misleading. Dr. Wolk of the CDPHE has said he didn’t think the McKenzie study supported the conclusions it made.
In late March, McKenzie wrote a commentary in the Denver Post correcting what she called “misinterpretations” of her team’s study. In an interview in her office at Anschutz days after her article was published, McKenzie was circumspect, choosing not to challenge the health department’s rationale and response to her study.
Several other health scientists familiar with McKenzie’s research were less guarded in their reaction. But they asked not to be identified because of concerns the oil and gas industry pulls the strings in the state, even at CDPHE, including purse strings that fund scientific research.
“You can connect the dots,” one researcher said during a coffee break at the recent science forum when asked if the state health department’s scientific findings seemed compromised by political pressure from industry.
Even if the political situation in hydrocarbon-friendly Colorado makes it hard for people like McKenzie and her colleagues to make strong public statements, other researchers here and elsewhere in the country are not as circumspect. “Mounting empirical evidence shows harm to the environment and to human health,” wrote Madelon Finkel, a professor of clinical healthcare policy and research at Weill Cornell Medical College, in a 2016 article in the American Journal of Public Health. “We have no idea what the long-term effects might be,” she said, and concluded that the stakes were too high to be silent. “Ignoring the body of evidence, to us, is not a viable option anymore.”
Colorado state health officials reject criticism that the CDPHE is anything but an honest information broker in the public health world. Van Dyke said the timing of the release of the CDPHE’s report was “completely coincidental,” not aimed to come on the heels of McKenzie’s study. “Our goal is to get information out to citizens as quickly as we can,” he said in an interview in his office, noting that the department was also concerned that it would be perceived as holding on to important information that residents and city officials wanted to know if it did not release its report when it did.
But given that the report’s conclusion was that the risk of harmful health effects is low for Coloradans living near oil and gas operations, it seems strange that the department would push the study out, before at least following the standard scientific protocol of having the study reviewed by an outside board. Van Dyke noted that the department will submit the literature-review portion of the report to a peer-reviewed journal. The department is also conducting a more comprehensive health-risk assessment, using new data from CSU, that will be completed in summer 2018.
Here in Colorado, in the absence of certainty about safety, critics of the CDPHE’s conclusions suggest that the health department and the COGCC take a precautionary approach by pressing the “pause” button on further fracking. Attempts to create bigger setbacks and insisting on more widespread and frequent air monitoring of well sites have both been met with industry reluctance if not outright defiance and political muscle. Many scientists wonder: Why not put the emphasis on proving that residents are safe, rather than letting uncertainty dictate business as usual until it can be proven that the operations cause cancer and other diseases? Residents like Bouche wonder how many people living near oil and gas wells will have to die or become ill before state agencies respond.
Bodies of evidence
Several communities on the Front Range and some legislators are pushing back against what they call the industry’s and state agencies’ saccharine words of assurance. Soon after the health department’s report was released, Sen. Jones learned about the report’s findings from CDPHE’s Van Dyke in a briefing to legislators. Held in a church near the state Capitol, the meeting was hosted and organized by the Colorado Oil & Gas Association, an industry trade group. It didn’t sit well with Jones that the CDPHE appeared too cozy with industry reps.
In early April, Jones spearheaded a letter to CDPHE director Wolk. Co-signed by 17 other house representatives and state senators, the letter charged that the department’s health-risk assessment was “dismissive of public health risks to Coloradoans” and that it has a “dismissive tone mirroring that used by oil and gas companies to justify their operations.” The letter claimed that the study should have used the “precautionary principle that an action should not be taken if the consequences are uncertain and potentially dangerous.”
Van Dyke replied in a letter to the state General Assembly in late April. It elaborated on the scientific methodology and findings of the report and said its conclusions “qualified as ‘based on available data.’”
Rep. Mike Foote (D-Lafayette), who signed the letter to the CDPHE, also recently sponsored two bills that would have tightened regulations on oil and gas development near homes and schools. Both were defeated in the Republican-controlled senate.
Some community groups have taken to the courts, charging state agencies with not putting residents’ health and safety first. Notably, a state appeals court in March ruled in favor of a group of Boulder teenagers, including Xiuhtezcatl Martinez and other members of Earth Guardians, who sued the COGCC. The group charged that state agencies are not considering seriously enough the health and safety of Colorado residents when reviewing applications for oil and gas drilling permits.
Among the health risks, as Bouche knows painfully well, is asthma. Research clearly shows that higher rates of asthma are linked to emissions from oil and gas operations, especially from volatile organic compounds (VOCs) such as benzene, a known carcinogen. Benzene is one of the constituents of hydrocarbons, including natural gas. By mixing with other hydrocarbon emissions, VOCs increase ozone levels, which is why they are called “ozone precursors.” Ozone pollution can aggravate lung diseases such as asthma, emphysema and chronic bronchitis, and it can cause chronic lung disease (COPD), according to the EPA. Several culprits contribute to the region’s ozone problem, including the oil and gas industry, vehicle exhaust, coal-fired power plants and certain weather conditions. Forest fires and volcanoes are also natural sources of benzene.
The Denver-metro and North Front Range areas have repeatedly violated federal ozone standards in recent decades. The EPA will likely designate the region this year as “non-attainment,” giving the state three years to show how it will meet the EPA standard, according to the state health department.
Several air-quality studies have shown that VOC levels are particularly high in some areas in Colorado where oil and gas is being drilled, especially in Garfield County and more recently on the Front Range. One study, conducted by Jessica Gilman and colleagues at NOAA, found that more than half of the VOC reactivity (meaning the ability of a VOC to promote the ozone formation) in the Denver-Julesberg Basin came from oil and gas activities.
“We do have an ozone problem here in Boulder,” said Pam Milmoe, program coordinator for Boulder County Public Health, in an interview in her office. “And we know from studies that oil and gas activities are contributing to the public health and air-pollution problems.” She and other County health officials had suggested to the County Commissioners that they extend the fracking moratorium until the CDPHE releases its next health-risk assessment next summer.
As Boulder County reluctantly opens its gates to new drilling permits, health officials will keep a close eye on ozone levels. The County has no legal authority to extend its five-year fracking moratorium following the Colorado Supreme Court’s 2016 rulings to overturn Longmont’s ban and Fort Collins’ five-year moratorium. “I think it’s important to the public health equation, that local government should have a say like we do with any other source [of pollution],” Milmoe said. “But that’s different for this industry.”
Oil and gas operators, she said, are “exempt from the type of controls that help us deal with issues like (well) siting and proximity to people and schools.”
How close is safe?
One reason why it’s tricky to pinpoint causal links is that various types of studies take distinct approaches and they sometimes don’t agree with each other. Some focus on emissions, others on exposures and others on pathways to disease.
Take for instance the production of hydrocarbons. By definition, this creates emissions. As noted above, multiple studies have shown that the quantity of those emissions is much higher than regulators have estimated. Some of these emissions are made up of compounds known to cause cancer and other health problems. We don’t yet know how much exposure to which chemicals in which population (children, elderly and immuno-compromised, for instance) are most at risk. But some things we know for sure, such as that benzene is carcinogenic, and that children are especially susceptible to exposures from benzene and other toxic chemicals emitted from oil and gas operations.
Then there is the question of exposure. In Colorado, McKenzie, her colleague John Adgate and others at the School of Public Health have led the charge on research on health impacts of exposure to VOCs. In one of their previous studies, the team found that babies born with congenital heart defects were more likely to be born to mothers living in the densest areas of oil and gas wells. They also found a relationship with birth defects of the brain and spinal cord. McKenzie’s research related to oil and gas development in Colorado began years ago with a health-impact assessment, published in 2010, for Battlement Mesa in Garfield County. The county had been the state’s number one producer of oil and gas until the boom shifted to Weld County on the Front Range.
McKenzie also has drawn from air-quality research including a study published last year and led by Hannah Halliday, an atmospheric scientist at NASA’s Langley Research Center in Hampton, Virginia (she was at Penn State University when she did the research in Colorado). Halliday found that “fugitive” emissions (from leaky equipment) of benzene from oil and natural gas operations in Platteville were the most likely causes of the area’s elevated benzene levels. Her research is part of the ongoing emissions-monitoring programs in Colorado, which NCAR’s Flocke and Pfister are also working on. Together the programs are called the Front Range Air Pollution and Photochemistry Experiment (FRAPPE) and DISCOVER-AQ.
Adding to the body of research on VOCs, NOAA’s Pétron was the lead author on a peer-reviewed paper in 2014 that found that benzene emissions from oil and gas operations, during a two-day period of sampling from aircraft on the Front Range, were seven times greater than what the EPA had estimated. The study also found that emissions of ozone precursor compounds doubled EPA estimates.
More recently and precisely, research by CSU’s Collett, corroborates Flocke’s and Pfister’s dramatic benzene-concentration findings. One of his studies, published last year, captured emissions — including the rate and dispersion of air toxics, ozone precursors and greenhouse gases — from specific oil and gas sites on the Front Range (different from those of Flocke and Pfister), based on canister samplings. Collett discovered benzene concentrations as high as 100 ppb in plumes within 100 feet from certain oil and gas operations. Most other air-emissions studies have captured region-wide emissions, by flying aircraft over a whole basin. Collett’s study also measured emissions from the various stages of oil and gas operations — from drilling to fracking to “flowback” (when injected water — actually a slurry of water, sand and fracking chemicals — comes back out), to production. He was surprised to find that emissions of benzene were highest during the flowback process.
“People shouldn’t be living within 100 feet from a flowback operation,” Collett said in an interview following his presentation at the science forum. But he added that high concentrations of benzene close to the flowback or other sources may pose a short-term health risk but not necessarily a longer-term risk.
Anxiety on the prairie
Some health impacts of drilling and processing hydrocarbons are more insidious and lesser known. In fact, very few studies have been conducted on the psychological toll of living near wells, including the constant roar of diesel trucks, the 24/7 hum of industrial activity, the flashing red lights atop drill rigs and the collective fear, anger and uncertainty among neighbors as they worry about their children, their health and their property values.
For Bouche, the psychological stress nearly rivals her asthma symptoms. “It’s the not knowing what’ll hit us next that’s so hard, and the lack of transparency from companies,” Bouche said. Asked if she plans to fight back, she paused and then said: “I love it here. I’m a Colorado native. But we’ve had enough. We’re moving to New Mexico, maybe Santa Fe, as soon as possible. …I don’t think they have much drilling going on there, and it’s beautiful.” She said her brother and his family, who live nearby, may follow them.
Despite a lack of specific data, mental health impacts are beginning to draw the attention of researchers. Stephanie Malin, a sociologist at CSU, has been studying social and mental health impacts of living near oil and gas wells in Pennsylvania, and more recently in Colorado. She is collaborating with McKenzie at CU Denver on a multi-year study. Preliminary data, based on interviews with people living near oil and gas wells in Greeley and other areas, suggest that many residents are anxious that they’ll get sick, their lifestyle will suffer, or their property value will drop. “There’s a combination of uncertainty and powerlessness that people feel,” Malin said.
Just ask 60-year-old Dawn Stein. Her white ranch home in Greeley’s Triple Creek neighborhood is precariously perched just across a horse pasture from a new 10-acre industrial facility owned by Extraction Oil and Gas. She knows all too well what anxiety and powerlessness feel like. The access road to Extraction’s new development is some 35 feet from her bedroom window. Although Extraction erected a sound-barrier wall between the road and her house (originally so high it blocked her view of the Continental Divide, before Extraction lowered it), she said the rumble of a truck passing can still jolt some paintings and some framed antique arrowheads out of position. Sometimes the roar makes her whole house shake.
She said the biggest “boom!” ever came on April 10 at 9:13 p.m. “The entire house felt like it moved. Lights flickered and I honestly thought one of the huge old cottonwoods had a limb come down,” she said. The City of Greeley has offered to buy her already devalued home, which she has lived in for more than 30 years. She’s holding out, but exhausted from battling the City and Extraction.
Collett’s air-emissions data from the Front Range study as well as another from Garfield County will be the basis of the new health report that the CDPHE plans to finish in summer 2018. That report will incorporate the CSU scientist’s emissions data from particular well sites and from the different phases of oil and gas operations. The data will then be analyzed and modeled to see precisely what the health impacts would be to people at different exposure levels.
“That’s the missing piece that we need,” said Milmoe of Boulder County Public Health. “We know what emissions are, but then the question is, one, are people being exposed to them? And two, are they being exposed at levels that are harmful?”
Collett welcomes the CDPHE’s use of his data to inform policymakers. “This health-risk assessment will give us a much better insight into whether current setback distances are adequately protective, or not,” he said.
Here’s another thing we know: Oil and gas operations leak. Regularly. For instance, researchers at NOAA and NASA, flying aircraft over oil and gas fields, have detected methane leaks from natural gas pipelines in the Four Corners area of the Southwest.
The CDPHE’s efforts, partly funded by COGCC, to locate these kinds of leaks are few and far between. The COGCC has its own field-inspection staff (30, up from nine in 2007), but still, scientists argue that this is scant relative to the types of monitoring that should be done.
So Boulder County has taken it upon itself to sniff out leaks.
On a crisp day in early April, Patrick Murphy, a Boulder County inspector, was aiming his FLIR infrared camera at an operating well pad in eastern Boulder County checking for gas leaks that cannot be seen by the naked eye. He calls it the “look, listen, smell” test. The technical term is AVO, for “audio, visual and olfactory.” His work has shown that leaks are discovered in 45 percent of the wells inspected in the County. Operators have generally fixed the leaks quickly when told about the problem, Murphy said. Today, he found no leaks to report.
As scientists continue to measure the growing impacts from oil and gas operations, they are finding that every stage of operations — from construction of well pads to drilling wells to transporting oil, natural gas and byproducts by diesel trucks or pipelines — produces some environmental and human health impacts. The risk of running these activities near houses, schools and hospitals is high enough to warrant that health officials and oil and gas companies at least step on the brakes — not the gas pedal.
“What we’re seeing from studies, including those of other researchers and in other states, is that people with an array of health outcomes, which include congenital heart defects, leukemia, asthma and some respiratory irritations, are more likely to be living in the higher-density areas of oil and gas development,” said CU health researcher McKenzie. “There are a lot of limitations to these studies, but they still don’t change that fact.”
You can find Susan Moran on Twitter @susan_moran
Thanks to The Story Group for making this project possible.