Transcription of Ed Miller for the show Healthy Lungs #63
Male: You are listening to the Dr. Lisa Radio Hour and Podcast, recorded at the Studios of Maine Magazine in Portland, Maine. Show summaries are available at doctorlisa.org. Download and become a podcast subscriber of Dr. Lisa Belisle at iTunes. See the Dr. Lisa website or Facebook page for details. Here are some highlights from this week’s program.
Ed: There’s not a lot of excitement when something doesn’t happen, when the water isn’t bad, or where there’s not a food poisoning outbreak, but I think the whole nature of public health is going to be changing and is starting to change.
Rebecca: For this kind of completely uncontrollable thing to happen, with no known cause, was a real challenge for me, and also an opportunity, a learning opportunity, for me to figure out how much inner strength someone can have, and also an opportunity for me to slow down and say, “None of us have control, and that’s okay,” and to embrace that.
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Lisa: This is Dr. Lisa Belisle, and you are listening to the Dr. Lisa Radio Hour and Podcast, show number 63, Healthy Lungs airing for the first time on November 25th, 2012 on WLOB and WPEI Radio, Portland, Maine. Today’s guests include Ed Miller, Senior Vice President of Public Policy for the American Lung Association Northeast, and Rebecca Falzano, lung cancer survivor and advocate for Lung Cancer Leaders and managing editor Maine Home and Design Magazine. Most of us spend very little time thinking about the air that we breathe, unless we live in a smoggy area. Here, in Maine, we tend to think things look pretty clean, so things must be pretty clean. It’s interesting because we are the smokestack of the Northeast.
Our area is impacted by particles that come all the way from the Midwest. This is something that Ed Miller, from the American Lung Association Northeast, has been working on for decades. It’s something that the public health world has been working on for decades as well. We’re very fortunate to have come as far as we have in this area. There’s still more distance to be covered. I know you’re going to enjoy this conversation with Ed Miller. Our conversation with Rebecca Falzano is pretty interesting for me because it hit home on a number of different levels. Rebecca was young when she was diagnosed with lung cancer. As a female, and a nonsmoker, this was an unusual diagnosis for her to have, and it’s something that impacted her life and her young adulthood.
She went through a lot. She made it through. Coming out on the other side, she really wants people to hear her side of it. Also, getting ready to welcome a new baby into her life and the life of her husband, Steve Pogson, she definitely comes across with this message of hope. This is also personal to me because my own grandfather died of lung cancer when my 16 year old was a baby. My Papae grew up in Biddeford. He lived there most of his life, and he wasn’t really a cigarette smoker. He had the occasional pipe. He also worked in a fairly industrial town, but it was never entirely clear to us as to what the direct causation was between what he had done in his life and the type of cancer that he had.
What was clear was that this was our Papae. This was our grandfather. It was very difficult to watch him get sick and die quickly, and leave our lives, and leave a hole there. I know I’m not the only Mainer who’s had this experience. I’m not the only person in the world who’s had this experience. It does give me a lot of appreciation for clean air and healthy lungs. That’s why I’m pleased to be able to offer this show to you today, who are listening, our show with Ed Miller and Rebecca Falzano. We hope you enjoy it. We hope you learn something along the way.
One of the first shows we did on the Dr. Lisa Radio Hour and Podcast was a show we called “Breathe,” in which we interviewed Dr. Dora Anne Mills, who was former Head of Centers for Disease Control in Maine, now at the University of New England. We thought it was important to revisit this topic here. It’s November, and we wanted to talk about breathing in air. We couldn’t think of a better person to come in and talk about this than Ed Miller, Senior Vice President of Public Policy with the American Lung Association of the Northeast. Thanks for coming in, Ed.
Ed: Hi, how are you? Glad to be here this morning.
Lisa: Well, I’m doing great. Part of the reason I’m doing so great is because there’s all this lovely clean air that I know that the Lung Association has been working on getting out there for the citizens of Maine for quite a long time now.
Ed: Quite a long time. We actually go back to probably 40 years ago with the Clean Air Act. Certainly, Clean Air Act has a lot of connections to Maine with Senator Muskie being the primary author of that, and then later Senator George Mitchell doing some significant updates to that. Maine has been a leader in the fight for healthy air, and I think we’ll continue to be. We have certainly some vested interest in it. We’re at the tailpipe of the nation. Without the Clean Air Act, we really don’t have a tool to keep our air clean. We could shut everything down in the state and still have pollution problems. That’s why we really do need to concentrate on what happens outside of our borders as well as inside.
Lisa: Well, talk to me about the Clean Air Act for people who are listening right now. What exactly did that mean? What did it bring about, and where did it come from? Why did they think it was important to put that act into place?
Ed: I think we ought to look to Senator Muskie and his vision. He saw a lot of polluted rivers. He saw a lot of polluted air in Maine from our factories. This was something that was common across the country. At the time, people really didn’t understand the health impacts. It was more, in many ways, aesthetic. They didn’t like the smell of people. Anybody that lives in the Portland area can remember that there were some pretty nasty smells in the air here 25, 30 years ago. You don’t get those anymore. The Clean Air Act was an interesting law in that it said, “What are the health standards that need to be met in terms of the concentration of air pollutants in the air that are not harmful?”
The scientists set what those limits were for carbon monoxide, or for particle pollution, or for ozone. Then, they said, “This is the area that we shouldn’t exceed. We shouldn’t have more than this in the air.” Then, separate from that, each state had to come up with a plan on to achieve that if their air was dirtier than that. That took into account things like cost-benefit analysis and what the most effective way to do that was. Some things that people almost take for granted these days were significantly the result of the Clean Air Act. The one I like to use most often is the catalytic converter on our cars.
We’re at a point today, quite frankly, our cars are probably cleaner than our lawnmowers, and certainly cleaner than our boats in terms of air pollution. That’s something we ought to be proud of. It’s been a major advance. It’s been one that has created jobs, created a technological capacity here in this country that’s been sported all over the world, and has cleaned our air and improved our health at the same time.
Lisa: Now, what is it about Maine that causes it to be, what you’ve called, the tailpipe of the Northeast?
Ed: Well, the prevailing winds are west-to-east and south-to-north. The meteorology of this is such that the air from across the country travels our way. As much as it might seem impossible, one of the biggest threats to the air quality in Maine are very, very large coal-fired power plants in the Midwest, and the Ohio River Valley, and those areas that, in many ways, have been grandfathered into under the Clean Air Act, have found ways around cleaning their mess up, delayed as much as possible. They’re still doing this today, trying not to clean up and go on as long as they can. We’re the recipients of this. We’re the ones, this is where the plume drops down. From the air pollution point of view, for particle pollution especially, a lot of those coal-fired plants are a major source of our air pollution.
Then, the other source, particularly in the summer, the ozone problem is one that, to a large degree, is from motor vehicle exhaust, and sunlight and heat. That’s something that comes to us courtesy of Massachusetts, and New York, and the whole eastern seaboard. That’s where the winds prevail. You know that we’ll get air pollution alerts in the summer when we get three or four sunny days in a row with a Southwest breeze, you’re going to have air pollution problems in the state.
Lisa: What does ozone do exactly? I know that people, if you’re watching the news, or you’re reading in the newspaper, there will be an ozone alert. What does that mean to people who are listening?
Ed: That’s a great question. Ozone’s a very intense respiratory irritant we like to refer to as kind of a sunburn on the inside of your lungs. It’s a good analogy in a lot of ways. It’s a good analogy in a lot of ways. One is that it does irritate the lungs, and that chronic irritation can cause problems, cause breathing problems in anybody, not just some people with lung disease. About a quarter of the population are especially sensitive to ozone whether or not they have lung disease. Those folks will experience this tightening in the chest. I remember as a kid growing up on the Jersey Shore, I used to think it was because we were swimming too much. We now know that that tightness in the chest was actually ozone pollution that we were inhaling.
It’s an irritant like that. It’s a cause of irritation to people with existing disease, but also people that don’t have any lung disease or heart disease still can be affected by it. Just like a sunburn, two of us can be exposed to the same amount and have very different reactions. I think that’s what’s important for people to understand. That’s why we tell people if you’re a heavy exerciser, or do you do an outdoor work really of any kind, during high ozone days, do that early in the day. Our problem here is worse later in the afternoon. One of the worst things you can do is nice, sunny, hot summer day, go out and bicycle or run at 6:00 at night’s probably not a great idea.
Lisa: I know that you’ve spent time with Deb Dietrich, who is part of the public health ground foundational structure for the state of Maine, who works at Maine Health now. She’s a friend and mentor of mine. I also know that you spent a lot of time with Gordon Smith, who we interviewed on our Future of Medicine show from the Maine Medical Association. Is it gratifying to see some of the work, that you started doing all those years ago, start to come to fruition and to have people finally believe in what you’ve been putting out there for so long?
Ed: It’s interesting. As I get older in this profession, it’s encouraging to see things that really we’ve been pushing for, for decades coming into a time where they’re more valued. I had to chuckle. I wrote an article back in 1977 on the health benefits of raising the cigarette that was published in the Maine Medical Association Journal. The story behind that is a funny one. Governor Longley was looking for a way to fund the first state employee pay increase, but he didn’t want to raise taxes. He asked the Commissioner if anyone could show that raising the cigarette tax would have a benefit on health, so I did some research and found out it could, so wrote up this article on it. He passed the tax, and the employees got their raise.
Now, we know that, for example, raising tobacco tax, one of the most effective and quickest ways to reduce smoking rates particularly among our kids. Some of these things have become much more common knowledge, much more common tools, in the public health toolbox. One thing in Maine that’s never changed, and I think it’s one of the reasons I’ve enjoyed working here so much is that we work very well together. This is a state where people know each other. They care about each other. The barriers among the organizations and various agencies and groups are nonexistent. People really do work very well. I’ve come to appreciate that even more as I’ve worked in other states where people don’t play so well together sometimes.
Lisa: Why do you think that is?
Ed: I think there’s a tradition of that, and there’s an expectation. Just like if you have children and you expect certain things of them, and you’re consistent in that, and people support that, that becomes the culture. I think it is the culture here. Certainly, there’s differences of opinion on things, and that. I know my colleagues, over many years, working, for example, with the Medical Society, with the Heart Association, with the Cancer Society, with the Health Department, we’ve worked very closely for many years on things. I think the issues that we’re dealing with are bigger than any one particular organization can deal with. I know our organization, especially our volunteers, expect us to work together. They don’t, public heath’s not a solo sport. It’s really a team sport.
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Lisa: Has there been a challenge with trying to get people to understand that the Lung Association is more than just lung cancer?
Ed: Well, it’s an interesting question. The challenge for the Lung Association is I don’t know if people think of us as lung cancer. They may think of the Cancer Society, too, sometimes on that. One of our challenges is that we’re more than just tobacco. I think that’s been a very interesting thing. The Lung Association goes back to 1911, we were formed. Unlike the other voluntary health agencies, like Heart and Cancer, we actually formed as a result of grassroots organizations getting together to form a statewide organization. There were … The major killer at the time was tuberculosis. People fought that hand-to-hand combat in communities.
Every county had a county TB association. They formed the Lung Association, or at the time the TB Association around 1911. That was a major killer. That was our focus. The name changed a number of times over the year. In fact, the Lung Association was a Public Health Association from 1920 to almost 1950. That shows you our organization always had a very broad base of concern around public health issues. Then, in the 60s, I think we entered into our second phase, which is really tobacco. We’re obviously still into that. We’re still into tuberculosis to a degree. We don’t just get rid of it. It’s an add-on. Now, I think the era of tobacco, we’re hopefully winding down. We’re still active in it. We’ll continue to be.
Our concern right now, and the major threat to lung health in this state and in the nation is around healthy air. That’s really going to be our focus, I think, for at least the next 50 years and keeping and making sure that the air we breathe is healthy.
Lisa: Talk to me about indoor air quality. You’ve mentioned some of the things that we think about for outdoor air particulates, and ozone. What about indoor air quality? Why is this an issue in Maine?
Ed: Indoor air quality in Maine is an issue for a number of reasons. One is it’s cold outside, and we spend a lot of time inside. That’s one thing. The second is that we live in a climate where, looking around this fall, we had a lot of rain. We’re not in a desert climate. That kind of climate, particularly when you also have some warm weather, you can end up with some mold problems. Mold is a problem in many indoor environments in Maine, and usually the result of leakage into the building or poor design. Another serious problem and in fact one that we’re also working on is radon. This is an odorless gas that is harmful to health. It’s the second-leading cause of lung cancer after cigarette smoking and second-hand smoke.
Radon’s a big problem. The good thing about radon is that it’s pretty easy to get rid of. You can do a test. You can fairly inexpensively get rid of the radon. If you’re building a new home, it’s very inexpensive to put radon protection in that new home. That’s another indoor problem. Then, one that people perhaps don’t think about as much, I guess I should just back up and say a major indoor air pollutant is if anybody’s smoking inside the house. That goes without saying. That’s probably one of the worst things that people can do. Fortunately, a lot more people in Maine are smoking outside. Even if they’re smoking at home, they’re smoking outside and not in their house, or their apartment, or any other kind of building like this.
Another area where we have some concern is around wood smoke. Maine has a lot of old wood stoves that date probably from the 70s when we had the initial energy crisis, and people expanded the amount of wood burning. There’s always been a lot of wood burning going on, but they expanded that. Part of the problem is these old wood stoves produce a lot of particle pollution inside the house. It’s not even the stuff that you see. It’s the very, very fine particles, that you don’t see, that are the danger. We’ve been working around the Northeast, and we’ll hopefully being doing some work in Maine on programs that change out old woodstoves for new woodstoves.
The new woodstoves, particularly the pellet stoves, there’s a 70-80 percent reduction in the amount of particle pollution inside from these. It’s significant. If people are considering, as we go into winter, changing out their stoves, they’re going to have a lot of benefits. They’re not just going to have the benefit of less outdoor pollution that they’re creating, and the higher efficiency, and being able to save on wood or pellets, but they’re also going to be significantly improving their indoor air. Those are probably the major indoor air problems in Maine.
Lisa: Is there an issue with VOCs, or volatile organic compounds, and building materials? Has this been something that you’ve seen happen?
Ed: I think people need to be careful about the building materials. They need to be careful about what they put into their homes, and how they perhaps renovate their homes. We’ve had, in the past, problems with people renovating around lead paint, and actually causing more problems than perhaps they even knew about. Fortunately, these days, we’re getting a lot more products that are low VOC. You can have paints, for example, that it used to be you’d paint a room, and you’d have to evacuate the house for a few days. Now, you can paint a room, and you could be in that room that evening. There are some products that I think people are getting smarter about the use of various products indoors.
We have a partner organization we do a lot of work with, the Maine Indoor Air Quality Council. If people are interested in particularly residential air quality issues, and to some degree commercial as well, Maine Indoor Air Quality Council’s a great resource. They have a great website. People can Google that and find out a lot more in this area.
Lisa: You’ve describe the challenges of being part of a public health organization that focuses on something that’s essentially odorless and colorless, and something we take for granted because we breathe it into our bodies. Well, hopefully it’s odorless and colorless.
Ed: Most of the time, yes.
Lisa: I know that there are some events that the Lung Association does to raise awareness. One of them is the Trek Across Maine. That takes place, I believe, in June.
Ed: In June. Father’s Day Weekend, yes.
Lisa: It seems to have really taken off.
Ed: It’s remarkable. I have the good fortune to have been working on the Trek Across Maine for 26 of the 28 years. I always say that it’s way more than a bike ride. This has been a way that the Lung Association has been able to recruit volunteers, to identify really impassioned people for our mission, to identify and recruit people who work with us year-round to really push the mission of the Lung Association and be our eyes and ears, and boots on the ground, throughout Maine, and really throughout the country. There are usually people from 28, 30 states, participate in this event. It’s a great event. It’s a wonderful experience.
It’s a very emotional experience watching people cross that finish line in Belfast, and just their accomplishment. This isn’t like waking up one morning and deciding you’re going to go do a two-mile walk. This is 180 miles on a bike saddle here, going uphill. Despite the fact that the sub-context of the Trek is from the mountains to the sea, it is not downhill by any stretch of the imagination. You can ask anybody that’s done it. It’s been a great way for us to get our message across. It’s been a great way for us to influence families. There are a lot of families that do this. We’re working now on three generations of people who have done this trek. It’s remarkable.
It raises almost two million dollars. It’s the biggest fundraising event in the American Lung Association nationwide. There’s nothing bigger than this throughout the country. It’s really a source of pride for Maine, and for the LA of the Northeast, that this event has been going on as long as it has, that it has grown from the first group of 100 people that raised $50,000, and rode the last day, rode 100 miles from Pittsfield to Bar Harbor in the rain. Remarkably, six or seven of those folks are still riding with us, and have ridden every single ride for 28 years. That’s a testament to the fortitude of people that do this event.
It’s great because it’s an event that raises money, certainly, but it also demonstrates our mission in many, many ways. It’s been a great fit. I’d be remised without tossing out a kudo to Peter King, who is the originator of Trek Across Maine, still here in Maine. It’s been an idea, and an event, that’s had many, many people contribute to its success.
Lisa: You also have an interesting and unique event, I believe, coming up in which we have done well for the state of Maine, out of state. Is that right? Firefighters?
Ed: Yes.
Lisa: Tell us about that.
Ed: Well, down in Boston, at 1 Boston Place, which is one of the taller buildings in Downtown Boston, which incidentally, when I mentioned working for public health in the past, happens to be the same building I worked in in the 70s when I was in Boston. It’s a 41-story building. We do a stair climb there. It’s a timed event. There are teams. There are individuals that do that. They climb up, as fast as they can, 41 stories. It’s two events. One event is for the general public and the teams, and they do their thing usually until about noon-time. Then, following that, there is an amazing, just amazing competition among firefighters from all over New England who, in full gear including the Scout packs, are heading up those corridors up to the roof of that building.
Anybody who knows fire departments know that they are a bit competitive, should I say? Portland has been just a great team. They’ve won a number of years. They’re battling the folks from Boston, and all over the Northeast at this point. It’s a fun event. It takes place in early February. You can go on our lung site, our website, lungne.org, and get the dates, and how to participate in it. It’s a lot of fun. There’s a lot of people from Maine that go down do it because it’s very unique.
Lisa: There’s also a phone number that people can call to get in touch with your organization.
Ed: Sure, 1-800-LUNG-USA is a easy way to get in touch with us. As part of that number, you’ll be prompted, if you want to talk to our Lung Help-Line, we have a live healthcare professional that’s there to speak to you about any aspect of lung disease. It’s either a respiratory therapist or a nurse that can answer your questions. It’s a great service. We have people from all over the country that are calling that number and getting information on how to improve their health.
Lisa: We’ve been speaking with Ed Miller, Senior Vice President of Public Policy for the American Lung Association of the Northeast. Thanks, Ed, for all the work you’ve done bringing clean air into the lungs of our Mainers. Thanks for coming in and talking to us today.
Ed: Well, thank you very much for inviting me and having this opportunity to talk with you.