By Sonja Isger
Palm Beach Post
PALM BEACH, Fla. — When Palm Beach County School Police officer Tony Makowski suddenly dropped 25 pounds off his 6-foot-2-inch frame this year, the first thing his doctor did was have him checked for cancer. Where Makowski was and what he did 11 years ago demanded it.
Makowski, 48, of Wellington, was among the New York City police officers who ran to the twin towers as thousands of residents and workers ran away.
As the 110-story buildings fell, he was showered in a toxic storm so blindingly thick people thudded into cars in their path. Then he spent months policing the surrounding streets that were flooded in an ankle-deep river of soot.
The smell was wretched and the ash inescapable, and it planted something even more permanent in the survivors and workers there: the fear that they would one day get cancer.
Until now, that fear was even more daunting because the $4.3 billion federal program created to compensate victims and cover the costs of treatment in survivors did not include cancer.
After declaring a year ago that the science could not yet prove a cause between that noxious downpour and cancer, the National Institute for Occupational Safety and Health on Sept. 10 agreed to add about 50 cancers to the list of illnesses covered under the Zadroga 9/11 Health and Compensation Act.
Makowski’s weight loss was tracked to an intestinal infection. But like hundreds, possibly thousands of others, he lives waiting for the other shoe to drop. Two other New York cop transplants now working with Makowski at the school district have been treated for cancer.
“They’re in their 40s, which just isn’t the norm,” Makowski said.
As for himself, “I go for a screening every year as part of the registry program just for the concern,” he said. “Who knows what we were breathing down there? No one seems to know.”
Estimated 1,000 die of attack-related illnesses
No air samples were taken that day or the first four days after the highest levels of air contamination occurred.
The samples taken after are “insufficient to provide quantitative estimates of exposure” to any one person or area, according to the scientists and doctors advising the government.
Although they haven’t identified every ingredient in the ashy cocktail created when the fuel-loaded jets exploded into skyscrapers, authorities do know that about 70 known and potential carcinogens were found in the smoke, dust and debris.
They include arsenic, asbestos, beryllium, cadmium, chromium, nickel, silica dust and soot.
There’s no doubt that the people who were there when the towers fell got sick. About 71,000 first responders, workers and residents of Lower Manhattan have enrolled in the World Trade Center Health Registry to have their health monitored and treated. Of those, 1,458 are now living in Florida, according to the registry -- at least 150 live in Palm Beach County and the Treasure Coast.
Illnesses related to the attacks have caused an estimated 1,000 deaths. But when the Zadroga Act passed in 2010 after years of failed attempts, the ailments covered were limited -- respiratory diseases such as asthma, chronic sinus infections, heartburn and acid reflux disease -- leaving people on their own to cover costs of other illnesses.
“I remember seeing a doctor on TV saying, ‘I’m sorry there’s no evidence to prove anything. People do die of cancer.’ I remember that and thinking, ‘Yeah, but why so many firemen and police officers?” said Al Hickey, a retired New York Police Department homicide detective now living in Port St. Lucie.
Hickey reports he’s “strong as a bull.” But he can count friends, co-workers and acquaintances who were there with him at the pile and who died of cancer.
John Feal, a former construction worker who worked on the pile and became an advocate in the resulting health issues, has been keeping count.
“That’s 345 after last night,” Feal said Friday.
Those are the ones he’s tracked through his New York-based FealGood Foundation. He is certain there are more. The number has eclipsed the tally of first responders who died that day, he said.
Getting health coverage for cancer has been one of Feal’s priorities. And he gives much credit to John Howard, a physician and the administrator of the World Trade Center Health Program.
After the first government look into the connection between 9/11 exposures and cancer came up empty last year, Howard asked the program’s scientific advisory committee for direction.
In March, the committee -- more than a dozen professionals including doctors, toxicologists and representatives of responders and survivors -- said it believed exposure to the building collapse and high-temperature fires that followed likely increased the probability of developing cancer. Members noted that some cancerous tumors take 20 years or more to show up, but already some small studies have found an increase in cancers among New York’s firefighters in seven years.
Given time, they expect more studies to back the connection. But rather than spend years waiting for such specific studies, they said they reviewed what is known.
They noted 70 known and potential carcinogens were in the air. Fifteen of them are classified by the International Agency for Research on Cancer to cause cancer in humans, and 37 are classified by the National Toxicology Program as reasonably anticipated to cause cancer.
They also reported many survivors and responders have since experienced chronic inflammation, which is “now believed to be an important mechanism underlying cancer.”
Rule details who and what are covered
The rule adopted last week follows the committee’s suggestion that the program cover cancers caused by the known human carcinogens and cancers in patients where high levels of inflammation are documented.
The program also will cover cancers that the science already has suggested responders are at a higher risk to develop, such as non-Hodgkin’s lymphoma and multiple myeloma documented in New York firefighters.
Health coverage extends to responders and survivors at the Pentagon and in Pennsylvania as well. The fund has 55,000 responders and 5,000 survivors enrolled with caps set at 80,000 and 30,000, respectively. Cost estimates include a possibility, but not a probability, of this population having a 21 percent increased risk of cancer. The estimated cost from 2013 to 2016 to include cancer coverage is $14.5 million to $38 million.
A responder or survivor who seeks coverage for cancer treatments must be first “certified” through the WTC health program, which has centers across the country.
The changes published Wednesday become law in 30 days.
“It’s a long time coming,” said Dennis McKenna, a 57-year-old federal agent who retired to Stuart. “It should’ve happened a long time ago. We’re all victims.”
McKenna knows at least three people who died young of cancers they believed to be linked to the toxins at ground zero: “Two police officers and one ATT telephone guy. It’s just a shame.”
“Of course, you wonder about it every day. It’s like walking around with a gun to your head,” McKenna said. “As first responders you stop a second before you respond and say, ‘Oh, mighty God, watch over me and if anything was to happen to me, look over my family.’ And you proceed and you don’t look back.”
But looking forward gives McKenna pause.
“We don’t know about our genes, those who had children in 2001 and forward. We don’t know about the genes in our kids if that’s going to follow them.”
About the compensation act
The 9/11 Health and Compensation Act, or Zadroga Act, is named after New York City Police Detective James Zadroga.
A New Jersey medical examiner blamed the disabled detective’s 2006 death on tiny World Trade Center particles embedded in Zadroga’s lungs.
But that finding was challenged by a New York City medical examiner who instead concluded the particles were remnants of a prescription drug abuse.
The act, which passed in January after years of failed attempts, both compensates and delivers health care to those affected by the attacks with $4.3 billion in federal money. The act sets aside $2.8 billion for further victim compensation and $1.5 billion for treatment of conditions linked to Sept. 11 -- including asthma, chronic cough and gastroesophageal reflux disease, and more than 50 types of cancer, including forms of breast cancer, lung cancer, colon cancer, leukemia and lymphoma.
The law and funding expire in 2015 and will have to be renewed. The money set aside in 2011 was not increased when the coverage expanded to cancer.
The fund currently has 55,000 responders and 5,000 survivors enrolled with caps set at 80,000 and 30,000, respectively. Cost estimates include a possibility, but not a probability, of this population having a 21 percent increased risk of cancer. The estimated cost from 2013 to 2016 to include cancer coverage is $14.5 million to $38 million.
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