Reference no: EM132688150

Case Study

Anytown had transformed itself from a 1950's small, poor town with a high unemployment rate to a 1970's industrial town known for it's plumbing supplies, including some of the largest manufacturing facilities of PVC (polyvinyl chloride) pipe in the nation. These industrial sites and factories were thought to be a godsend to this small town, offering jobs, a boost to the local economy, a reputation as a true, hard-working, blue collar town, and a bit of esteem and recognition as the place to go if one were in need of plumbing supplies, clothing, upholstery, electrical cable insulation, inflatable products, and more.

During this short 20 year period, more and more Industrial workers in Anytown, USA were becoming ill. In retrospect, individual cases involving the mentioned symptoms began to arise in just months after the industrial park factories opened, increasing in number as time went on, raising the suspicious nature of doctors in the area. Doctors began to investigate by calling workers (both symptomatic and asymptomatic) to come in for health evaluations. During these physical exams and a battery of tests individuals were found to have portal hypertension related to sinusoidal endothelial damage, angiosarcoma of the liver, and potential cases of hepatocarcinoma. Doctor's found elevated gamma-glutamyltransferase (GGT) concentrations in workers. Though elevated GGT levels did not fit, Drinking, a primary cause of liver disease, was thought at first to be an obvious culprit. However, drinking was eliminated as a primary effector since the majority of individuals truthfully conveyed they did not partake in alcohol consumption of any significant amount either currently or in the past. Likewise, viral causes of liver disease and liver cancers, such as Hepatitis C, were eliminated as well, since most patients tested negative for Hepatitis C exposure. Doctors were puzzled.

Eventually the thinking shifted to consider toxic byproducts and routes of exposure to toxic compounds. As investigations continued, and it did seem that there was some correlation to the industrial renaissance and this onset of corresponding symptomology. Individuals in the town were polled. Investigators focused on those individuals who lived or worked in close proximity to the factories. Studies showed that though there were a significant number of cases among individuals in very close proximity (less than 1 mile) of the Industrial park/factory sites, many individuals living more than 5 miles away were also showing symptoms. It was also found that of those individuals with symptoms outside of the 5 mile radius of the industrial park, 97% of them worked in the factories themselves on a daily basis. This started to point a finger toward the factories. However, symptomatic individuals had jobs that ranged from being "floor" workers with direct contact to product to administrative assistants housed in the same facilities, but with no direct physical contact to the products. Officials began to suspect that they may be dealing with an airborne carcinogen or toxin. They attempted determine if there were any odors that could be detected in proximity to the factories, finding that no significant odors existed. However, with physical contact eliminated as a source of exposure to a toxin, very few routes of exposure remained, including the respiratory route. Upon further investigation Doctor's found something in the air that was the likely culprit.

Regulatory measures put in place in the 1970's after this investigation produced a marked reduction of new cases of this disease. However, those individuals exposed to the agent prior to the regulations demonstrated that inhalation absorption of the substance was not only quite rapid, but data from volunteers exposed to low concentrations of the substance also showed that they retained more than 40% of the inhaled amount.

Questions:

1. What could this toxic agent be?

2. Where might it have come from (be as specific as you can)?

3. How might you explain the facts in the case above (proximity effects on towns people living close versus far from inductrial sites, liver symptomology, etc.) to support your argument?

4. Do you think modern day EPA and Federal regulations (if they were similarly in place in the early 1950's) would have been effective in countering this "unknown" problem before it started to effect individuals, or do you think that even with regulation in place this threat might have occurred the same way? Why? Justify your answer.