By Dr. Paul Ehrlich
The other night at a meeting of the New York Allergy and Asthma Society we heard a presentation by Matthew S. Perzanowski, PhD, of the Mailman School of Public Health at Columbia University. Matt did his graduate work in Sweden around the Arctic Circle where there are no dust mites (too dry) or cockroaches (the people are very conscientious in their housekeeping) but still have a 10% rate of allergic asthma. The culprits? Dogs and cats.
The story he told was very compelling on the one hand, the neighborhood-by-neighborhood study of pediatric asthma in New York City. But very frustrating for a clinical allergist on the other because his data showed the extent to which asthma exacerbations, measured in trips to the doctor and hospital, irrespective of class, race, or anything else, really depends on where you live, particularly on proximity to sources of “black carbon”. To wit highways, bus depots, and even furnaces that burn “residual oil”, which he described as so thick that it’s not even liquid at room temperature. Older buildings have received a waiver of compliance with more modern requirements. Larry has written repeatedly about the concentration of asthma in Hunts Point, with its 12,000 produce bearing diesel deliveries every day.
This story was frustrating to me because the crux of treatment in private practice is pharmaceutical and behavioral. “Here’s your medicine….Take it twice a day.” “Dust your apartment.” “Take out the trash.” “Don’t let anyone smoke in the house.” And so forth. But meds and admonitions only go so far when what triggers many exacerbations is not underlying allergies, but the output of those black carbon sources. The team at Columbia can measure the likelihood of episodes in tens of yards from the nearest dirty apartment furnace. “My block good; your block bad.”
So what is a doctor to do? I can’t tell people “move.” Most things like bus depots and garbage terminals are placed in neighborhoods where the residents have the least say in city planning. It’s a chicken-egg, vicious-cycle, NIMBY situation that has built up over decades.
The real “treatment” for doctors lies in advocating for policy. Oh, I know a few hundred allergists in New York can’t get the highways moved, but maybe we can get the city government to act to expedite furnace conversions. It’s too bad no economist has found a way to finance current infrastructure upgrades out of the future savings in health care costs, and greater productivity at work and in school.
Graphic: New York City Department of Health and Mental Hygiene