Waiting to Inhale 

It's a killer we seldom hear about, discriminating by race and locale and afflicting more people every year. So why don't we even know what causes asthma?

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One reason for the scant research on these environmental factors is that a large number of these studies are funded by drug companies, which prefer to look at the more profitable treatment end of things rather than prevention and etiology, or cause, of a disease. "That's the case with almost every disease," says Adam Davis, program director of the American Lung Association of the East Bay, who points to AIDS as an example. More money goes into researching HIV medications than creating a vaccine, he says. "If we put more money into prevention, we could prevent hospital bills," Davis says. "The reason why so much money is put in treatment is that's where the money is to be made for pharmaceutical and biotech firms. They can sell the treatment, but they can't sell the prevention."

The biggest funder of etiological research is the federal government. Three entities, all within the National Institutes of Health (NIH), provide most of the funds: the National Heart, Lung, and Blood Institute (NHBLI); the National Institute of Allergy and Infectious Diseases; and the National Institute of Environmental Health Science.

Yet even the government seems to favor treatment research. The Pew Environmental Health Commission published a report with the Johns Hopkins University School of Public Health in 2000 that evaluated the government's response to the asthma epidemic. It found that, of the $125 million budgeted for asthma research in 1999, less than seventeen percent was dedicated to the study of asthma etiology. Less than nine percent went to research on prevention and less than one percent to tracking the disease. The remainder -- more than seventy percent -- was spent on treatment and biomedical research to identify the basic cellular processes and mechanisms.

The commission sharply criticized the Department of Health and Human Services, the nation's public health agency, for not doing enough when it came to asthma. But James Kiley, director of the division of lung diseases at the NHBLI, considers the spending balanced. "It depends on how you categorize the different grants. One person may look at a grant and say that's preventive and someone else may say, 'Yeah, but it has some small protocol looking at one treatment versus another so that can be categorized as treatment,'" he says.

Kiley points out that the NIH has increased funding for research over the last decade. In the fiscal year 2001, it spent $140 million, he says.

Yet some types of research still get more attention than others, says UCSF asthma researcher John Balmes. "More money is geared towards understanding the genetics of asthma because that's sexy right now," he says. "People are trying to connect diseases with genes, and asthma gets caught up with that.

"Etiological studies by their very nature are expensive and take a long time," Balmes adds, noting that clinical research usually costs less. "There's a tendency to fund things where you can get a bang for your buck quicker."

Research funding also has a political element, says Tina Cosentino of Communities for a Better Environment. "I think it's very political to do any proof that asthma is directly related to pollution," she says. "It's not that health agencies aren't interested -- they are. It's just in terms of where funding gets allocated, these agencies get lobbied by a lot of these big companies. It prevents them from finding correlative evidence."

Attempts to link health problems to pollution, and hence to auto- and industrial-emissions regulations -- or lack of them -- indeed make for political games. One need look no further than the White House, which recently proposed a "Clear Skies" initiative to relax pollution standards for utilities upgrading old power plants. EPA administrator Christie Whitman, armed with computer projections, claimed such a move would actually improve national air standards for fine particles and ground-level ozone, as well as reduce the number of children hospitalized for asthma.

Cosentino says regulations are already minimal on factory smokestacks, release valves, and industrial flares -- chimney-like chemical incinerators. Communities for a Better Environment has pressured the Bay Area Air Quality Management District to assess the amount of local pollution from these sources.

But sometimes the government fails to keep tabs on the data it already collects. Although air district inspectors check on plants and take their own samples, some data, such as the Toxics Release Inventory, are self-reported by polluters. Consider the TRI numbers for the Red Star Yeast factory. From 1994 to 1996, Red Star reported emissions of fewer than 2,000 pounds of carcinogens per year. By 1998 it had jumped to 33,000 pounds. Palaniappan of the Pacific Institute asked company representatives about the disparity. She says they told her they mistyped the numbers for those years, and that in fact the numbers had always been around 30,000 pounds.

Plant manager Mike Cunningham says he can't verify this, but agrees that emissions have been stable. "I have no idea why they were that low. Nothing has changed after that time to make it increase," he says. In any case, he adds, the plant has significantly reduced emissions since Lesaffre Yeast Corporation bought Red Star in February 2001.

Still, the incongruity frustrates Palaniappan. "I don't want to say they lied, but they misrepresented their emissions," she says, emphasizing that the mistake went unnoticed by the EPA. "The bottom line is that the hands of public-interest organizations and community organizations are tied because we rely on information that we're now told is misrepresented and inaccurate."

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