By Matthew S. Freiberg, MD, MSc, Assistant Professor of Medicine and Epidemiology, University of Pittsburgh

First and foremost, the issue at stake here is Pittsburgh’s need to have clean water for overall public health as well as for economic viability now and in the future. It should go without saying that if Pittsburgh is labeled a city with contaminated or polluted water, Pittsburgh will have an impossible time recruiting new businesses to the area, maintaining the businesses it does have, and it will be saddled with the economic burden of clean up plus health care costs.

Therefore, it is essential that Pittsburgh acts to ensure that its water sources remain clean.Pittsburgh should be vigilant about its water supply because recent events suggest industry has not always been correct.

Not so long ago, the American public was told by the Tobacco Industry that “nicotine is not addictive” and “smoking does not cause lung cancer.” We, of course, now know this is not true, but the damage has been and continues to be done every day all over the world. As a physician in Pittsburgh, I can tell you first hand that our community continues to pay a huge price for these huge mistakes.

More recently, the American public was told that the banking industry did not require intense regulation or oversight because “the market” would correct any problems. Is there is any one in America right now who believes that the banking industry should oversee itself?We are now told that our drinking water is “safe” based on recent testing in our local rivers, and our newly elected officials are suggesting that additional regulations for the Natural gas industry are not necessary.

My response to these comments is that history often repeats itself, but it does not have to.So, how should Pittsburgh approach this problem?

Consider the following story about a patient named Mr. Pittsburgh

Mr. Pittsburgh presents to the hospital with chest pain. Mr. Pittsburgh smokes, has high blood pressure, and high cholesterol. Mr. Pittsburgh and his family are concerned he is having a heart attack. The doctor agrees and decides to check his blood for evidence of damage to his heart. After an hour of waiting, the doctor returns with good news: Mr. Pittsburgh has not had a heart attack. However, the doctor does tell Mr. Pittsburgh that checking his blood is not the way to prevent a heart attack. Checking his blood only tells him if he has had a heart attack. The way to prevent the heart attack is to quit smoking and to lower his blood pressure and cholesterol. The doctor also explains to Mr. Pittsburgh that if he continues to smoke and have high blood pressure and high cholesterol that he will likely have a heart attack. This heart attack may kill him. If Mr. Pittsburgh survives his heart attack, he may still have a permanently damaged heart. At the very least, the doctor says that Mr. Pittsburgh will require medication that can be very expensive for the rest of his life.

The case of Mr. Pittsburgh is exactly what we are facing with drilling for natural gas and protecting our drinking water. While I applaud the initiative to check the water, the answer to protecting our drinking water for the good of our public health and economic viability lies in prevention. The keys to prevention are ensuring that the processes by which natural gas is extracted, the chemicals used in the process of FRACKING, and the disposal of waste water associated with FRACKING are safe.

How does Mr. Pittsburgh ensure safety?

Well, let’s take a look at the some of the regulations that are required for a new medicine to be used on patients.

When physicians conduct clinical trials involving patients to determine if a new medicine is safe and effective for people, the physicians and scientists conducting the trial are NEVER allowed to be in charge of overseeing the safety issues involving their own trial. There is a completely separate group of physicians and scientists who serve on a Data Safety Monitoring Board (DSMB). The DSMB’s job and responsibility is to ensure the safety of the patients in the study and the DSMB has the authority to stop any trial that is a danger to the patients in the trial. This is a good system because it reduces the possibility that a conflict of interest will occur between the physicians and the outcome of the trial. Allowing physicians to run studies while also determining whether the study is safe for the participants is a clear conflict of interest and it compromises the integrity of the science.

So if medicine requires this level of oversight to protect patient safety, why should the natural gas industry not be subject to the same strict oversight? Ensuring clean drinking water is just as vital to a person’s health as is ensuring that the medication a patient takes is safe. Given what is at stake, public health and sustained economic viability of Mr. Pittsburgh’s city, Mr. Pittsburgh should demand the same level of independent oversight of the natural gas industry as is currently practiced and strictly enfored for clinical trials involving new medications.

Why should we consider re-evaluating the FRACKING Mechanism or any part of the drilling process for that matter?

In medicine, we are always reviewing, re-evaluating, and reconsidering patient treatment guidelines. The reason we do this is because new science is always happening and sometimes new science suggests a better way to care for people or that our current way of caring for patients may not be as safe as we once thought. In the case of FRACKING, recent documents provided by the New York Times suggest that this process poses more than a reasonable risk to our drinking water supply. Like science, laws, policies, and regulations need to be constantly revisited and changed when appropriate. In Mr. Pittsburgh’s case, it is no longer clear, based on the new science that our current laws, regulations, and policies are adequately providing the necessary protections to ensure clean and safe drinking water.

Final Thoughts

Pittsburgh and SW Pennsylvania are sitting on one of the largest sources of natural gas anywhere. Companies are going to want to drill here, and they will make large amounts of money doing so. While there may be benefits for Pittsburgh and SW Pennsylvania in terms of jobs and revenue, there are clearly risks associated with this drilling. There is very little doubt the current situation is a “win” for industry. What we (Mr. Pittsburgh’s community) need is to be sure of that there is a win for us, our children, grand children and future generations long after the natural gas is gone and the natural gas companies have left. It is precisely the “win” for us that I am concerned about and I believe is not being adequately addressed.How might we “win” in this situation?

We can only “win” if the water supply remains undamaged. We will surely lose our health and our economic viability if our water is polluted. We will not be the only “loser” either. Our families, children, and future generations will also “lose” if we don’t “win.”

To help us “win,” we should demand of our U.S. Senators, U.S. Representatives. Director of the EPA, Governor, Legislature, local officials, and the industry itself the following:A true preventive strategy: continue regular random checks of drinking water sources—both rivers and well water for those closest to the drilling PLUS regular random checks of the drilling wells, waste water, and waste water disposal processes—checking water only tells us that a “heart attack” has happened. What we need is to prevent “the heart attack.”

Stricter oversight of the natural gas industry by a “Data Safety Monitoring Board”, preferably not affiliated with the state of Pennsylvania in order to minimize any conflict of interest: Clean water is just as important as safe medicine and it requires the same level of oversight as a new medicine in order to protect us, our family, friends and neighbors from having “a heart attack.”

An efficient and expedited review of the FRACKING materials and procedures and processes for monitoring waste water and waste water disposal. New information requires new evaluations. Our health and the area’s economic viability for the future requires that all procedures associated with natural gas drilling be safe and present no threat to the drinking water supply. The determination of whether FRACKING and other procedures are safe should again be conducted by a Data Safety Monitoring Board.

Because no one can possibly tell everyone who needs to know about this issue, we should ask for the following help:

• The local newspapers, radio stations, and television stations should continue to follow this topic understanding that this process of drilling will last years.
• The Carnegie museums should have an exhibit on the Marcellus Shale. This exhibit should clearly state the potential benefits and clear risks affecting the region of SW PA and Pittsburgh by drilling for natural gas.
• Universities, colleges, and school districts in SW PA should educate students about the Marcellus Shale and how this natural gas drilling will affect their everyday lives. This information will be essential as they decide how to deal with this process including who to vote for and on what policies to vote for so that our drinking water and economic viability remain secure.

In my opinion, the current conditions are NOT a “win win” situation for us. Without a true preventive strategy, stricter oversight, a serious review of the FRACKING procedure, waste water, and waste water disposal, and sustained community involvement, I think we are all in danger of losing our clean drinking water and with it our health and the economically viability of our community for now and for future generations. We all understand that the decisions of today will impact several future generations, and the impact of these decisions will be present long after the natural gas and the natural gas industry are gone.

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Matthew S. Freiberg, MD, MSc
Assistant Professor of Medicine and Epidemiology
Division of General Internal Medicine and Center for Research on Health Care
University of Pittsburgh
230 McKee Place, Suite 623
Pittsburgh, PA 15213
telephone 412 586 9847
fax 412 692 4838
email: freibergms@upmc.edu