Reference 10.pdf
All-
I want to thank Dr. Rose and Mr. Wright for providing these documents. I've read through them and made
notes, and J thought I'd share my notes here. There are days when I just can't find the time to comb through
references, so if you are having that kind of day, I hope that these notes will help.
Attachment #1 from the NRDC (1999) indicates that bottled water isn't always safe. One of the reasons
why, interestingly, is that it sometimes contains Trihalomethanes. Two references notes in the article
contain site 8 studies found adverse health effects associated with TTHM (in the 1990s).
o RD. Morris, "Chlorination, Chlorination By-Products, and Cancer: A Meta Analysis," American
Journal of Public Health, vol. 82, no. 7, at 955-963 (1992); EPA, "Proposed National Primary
Drinking Water Regulations for Disinfectants and Disinfection By-Products," 59 Fed. Reg.
38668 (July 29, 1994); NRDC, U.S. PIRG, and Clean Water Action, Trouble on Tap: Arsenic,
Radioactive Radon, and Trihalomethanes in Our Drinking Water (1995)
o S.H. Swan, et al., "A Prospective Study of Spontaneous Abortion: Relation to Amount and
Source of Drinking Water Consumed in Early Pregnancy," Epidemiology, vol. 9, no. 2, pp. 126-
133 (March 1998); K. Waller, S. H. Swan, et al. (1998). "Trihalomethanes.in Drinking Water
and Spontaneous Abortion," Epidemiology, vol. 9, no. 2, pp. 134-40 (1998); F. J. Bove, et al.
"Public Drinking Water Contamination and Birth Outcomes,” Amer. J. Epidemiol. , vol. 141, no.
9, pp. 850-862 (1995);see also, NRDC, U.S. PIRG, and Clean Water Action, Trouble on Tap:
Arsenic, Radioactive Radon, and Trihalomethanes in Our Drinking Water (1995).
Attachment #2 is a 1995 article that finds no strong link between TTHM levels and abortion or low birth
rate. In doing a quick google scholar search, I found numerous articles that have been published since
1995, some of which make a correlation between exposure and birth defects, such as:
e S. Kumar, et al. "Total trihalomethanes in public drinking water supply and birth outcomes: a
cross-sectional study," Journal of Maternal and Child Health, vol 18, no. 4, 996-1006 (2014).
' This article notes a small increase in risk for low birthweight and pre-term births for
chronic low maternal exposure to THMs.
Attachment #3 (2003) is a Russian study that evaluates the efficacy of home filters in removing TTHMs.
The authors of this article do not seek to determine whether or not TTHM levels can result in adverse
health effects... instead, the article states that adverse health effects are likely for pregnant women
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who are exposed to TTHM. The focus of the article is on finding an effective method for ridding water
ofthe TTHM.
Attachment #4 (1999) from the EPA provides information on the importance of removing
cryptosporidium from tap water, especially for people with compromised immune system. I'm not aware
of previous or current test of the Flint river that detected cryptosporidium. That's the only reason I can
think of for adding the topic to this discussion.
Attachment #5 (2006) This Water Research Journal article discusses the effect of boiling on the level of
TTHM is the water. Depending on which trihalomethane is being measured, the level increases or
decreases.
Attachment #6 Author unknown - perhaps this is a draft document to be included with the upcoming
notification. This TTHM fact sheet suggests that the risk of adverse health effects after exposure to
TTHMs is small, or that the number of people affected by TTHM is minimal. The statements made are
vague and aren't supported by the other papers included in this email message.
Attachment #7 Again, author unknown. This document addresses the risks of cryptosporidium in drinking
water, and casts doubt on the benefit of bottled water. The article states that THM is known to increase
the risk of certain chronic diseases after long term exposure (without defining exactly what “long term"
means), and that TTHMs can cause immediate adverse health effects in vulnerable people. The article
notes that TTHMs have been associated with birth defects and premature births.
Attachment #8 discusses the options that people with compromised immune systems have for dealing
with water that may have bacteria in it. Adding chlorine is not listed as an option.
After reading the attachments, I still felt unclear regarding the health effects of TTHM, and wanted to see if
more recent research has been conducted and published. I searched and was able to find a number of literature
citations.I am pasting here a list of articles I found, and attaching a document that contains the abstracts for the
first 6 of the references. The full articles for references 7-10 are attached. I am a materials engineer, and not
familiar with the academic literature on water research. For that reason, I may have missed pertinent literature
published in the past 8 years. Still, it seems that the research I did find supports a correlation between TTHM
exposure adverse health effects.
1,
J. Lee, et al. "Occurrence of disinfection by-products in tap water distribution systems and their
associated health risk." Environmental Monitoring and Assessment Vol. 185, no. 9, pp 7675-91 (Sept
2013).
E. Rincén-Bedoya, et al. "Mutagenicity and genotoxicity of water treated for human consumption
induced by chlorination by-products," Journal of Environmental Health, Vol. 75, no. 6, pp 28-36
(Jan/Feb, 2013)
S. S. Tsai, et al. "Trihalomethanes in drinking water and the risk of death from esophageal cancer:does
hardness in drinking water matter?,"Journal of Toxicology and Environmental Health, Vol 76, no. 2,
120-30. (Jan/Feb, 2013)
S: Chowdhury, " Disinfection byproducts in Canadian provinces: associated cancer risks andmedical
expenses," Journal of Hazardous Materials, Vol 187, pp. 574-84 (March, 2011)
M. Basu, “Multi-route risk assessment from trihalomethanes in drinking water supplies," Environmental
Monitoring and Assessment, Vol 178, pp. 121-34, (Jul, 2011)
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6. GE. Bove, et al, "Case-control study of the effects of trihalomethanes on urinary bladder cancer risk,"
Archives of Environmental and Occupational Health, Vol 62, no. 1, pp. 39-47 (Spring, 2007)
7. J.M. Wright, et al, "Effect of Trihalomethane Exposure on Fetal Development," Occupational
Environmental Medicine, vol 60, pp. 173-80 (2003).
8. J.M. Wright, et al, "The Effect of Disinfection By-Products and Mutagenic Activity on Birth Weight
and Gestational Duration," vol 112, pp. 920-25, (2004)
9. L, Stayner, et al, "Exposure to Brominated Trihalomethanes in Water During Pregnancy and
Micronuclei Frequency in Maternal and Cord Blood Lymphocytes," Environmental Health Perspective,
vol 122, pages 100-106. (2014)
10. M Rahman, et al. "Colon and rectal Cancer Incidence and Water Trihalomethance Concentrations in
New South Wales, Australia," BMC Cancer, Vol 14, pp. 445 (2014).
T am glad to have the opportunity to serve on the technical advisory board, and I hope that the day I spent
pulling this information together helps us all to become more familiar with the implications of elevated TTHM
levels in water, and brings us all closer to a solution for the residents of Flint.
Sincerely,
Dr. Laura Sullivan
Kettering University