ORRHES Meeting Minutes
December 3, 2002

Public Comment

Bill Murray asked about the dosage received to the parathyroid when the thyroid received radiation doses to treat cancer, and if there was any damage to the parathyroid gland. In addition, what other tissues in the body does iodine go to besides the thyroid? Dr. Hershman stated that parathyroid damage does not occur after radioiodine treatment for thyroid cancer. It is very resistant, and only a very few cases have been reported. As for the second questions salivary glands may experience damage or loss of salivary function from the radioiodine treatment. There is the same function in the lining of the stomach also has iodine transport, but there has never been any damage or cancers reported.

Theresa Chen stated that recently she was diagnosed with Hashimoto’s disease and asked for brief summary of what this disease is. Dr. Hershman responded that it is a chronic autoimmune inflammation of the thyroid that is common in the population and occurs more frequently with age.

Peggy Adkins stated that Terry Lewis’ case seemed very similar to some people she knew in this area years ago. In 1963-64 doctors were referring young girls to a doctor in Crossville, Tennessee for underactive thyroids. There was no family history of those diseases. Is there any connection between estrogen and these diagnoses in multiple families? Dr. Hershman stated that the most vulnerable group for Hashimoto’s disease today is adolescent girls, aged 12-14. In regions of moderate iodine deficiency the most vulnerable population are adolescent girls. It may be estrogen-related, but the data is very weak. Peggy Adkins noted that the mothers of these adolescent girls developed diseases like Lupus and MS at menopause, and asked if there was any study that looks at the relation of disease, estrogen, and thyroid? Dr. Hershman stated that he knew of one study showing that a very high proportion of women who had Lupus also had Hashimoto’s disease. If you examine Hashimoto’s patients only a small percentage have Lupus. It could be a family related tendency. Peggy Adkins asked if there is information on research on thyroid effects from exposures to a multitude of contaminants. Dr. Hershman responded that there is some interest now in environmental toxins and how they could affect the thyroid. I have a colleague, Gregory Brent, who is on a national committee studying the effects of environmental toxins on the thyroid.

Kowetha Davidson asked if there was a connection between post-partum depression and post partum hypothyroidism. Dr. Hershman responded that there has been a connection between post-partum depression and post partum thyroiditis with hypothyroidism. The majority of post partum depression is unrelated to post partum hypothyroidism.

Break

Work Group Recommendations

AGENDA WORK GROUP
Barbara Sonnenburg was no longer present, but asked for suggestions for the agenda from the Subcommittee.

GUIDELINES AND PROCEDURES WORK GROUP
Karen Galloway was not present, and there was no task assigned to this Work Group at this time.

COMMUNICATIONS AND OUTREACH WORK GROUP
James Lewis asked that Theresa NeSmith submit a Needs Assessment report from another site’s Needs Assessment so that the Subcommittee with have an example work product to become familiar with.

HEALTH EDUCATION NEEDS ASSESSMENT WORK GROUP
Donna Mosby reported that there were no recommendations at this time.

PUBLIC HEALTH ASSESSMENT WORK GROUP
Bob Craig reported that there are no recommendations at this time, but mentioned that Tony Malinauskas has agreed to lead the public health assessment on uranium releases from Y-12. There will a recommendation from the Work Group at the next ORRHES meeting regarding cancer data to request from the State of Tennessee.

James Lewis commented on the there is low attendance at the Work Group meetings, which may leave some Subcommittee people under-informed as public health issues are addressed (i.e. The cancer registry data request). Bob Craig encouraged that anyone who would like to be considered for, or provide input to, the Work Group looking at the cancer registry data to contact Pete Malmquist, Tony Malinauskas, James Lewis, or George Gartseff.

Kowetha Davidson suggested a brief summary of Work Group topics during the Work Group meetings to inform everyone of what is going on.

James Lewis commented that some recommendations from the Public Health Assessment Work Group, October 22, 2002 ORRHES meeting, did not pass and there was some question as to if they should be revisited. The Subcommittee needs to be aware of the importance of some recommendations, even if the do pass a vote of the Subcommittee. Bob Craig suggested that the recommendations be resubmitted for discussion during the Work Group meeting. Donna Mosby stated that the PHAWG recommendation did not have support material to make a decision on, and that there needed to be material to review in order for members to make a decision, and asked what the task of the Cancer Registry Group is. Kowetha Davidson explained that in the last Subcommittee meeting there was a request that Toni Bounds provide incidence rate data for certain cancers in our 8 county area. This group will be deciding specifically which cancer rates in the area will be requested. Currently the maps show all cancers, and the Subcommittee needs to be selective in deciding which information is going to be useful, and will be presented to the Subcommittee in a way that shows the relationship to what we are doing. They are going to narrow down the list of what specific types of cancer will be included (e.g. thyroid). Bob Craig confirmed that the Public Health Assessment Work Group will have a recommendation concerning cancer registry data requests at the February 10 ORRHES meeting. The PHAWG has 3 meeting scheduled before the February 10 meeting at which the recommendation will be developed. Paul Charp has made a thorough presentation on the screening dose (MRL) at the October 22 meeting that contained sufficient information for Subcommittee members to make an informed decision.

Kowetha Davidson stated that it is the responsibility of the PHAWG to decided whether or not, and how to, present the issue again to the Subcommittee. James Lewis emphasized that certain public health issues, such as the screening level, need to be condensed for the benefit of lay-people and Subcommittee members. Kowetha Davidson replied that it is the responsibility of the PHAWG working with Paul Charp. Jerry Pereira reminded Subcommittee members that it is incumbent on work groups to bring that information to ORRHES for decision-making. It is also incumbent that each Subcommittee member to ask for clarification on issues that need it. Work groups are an entity that is necessary in regards to the volume of information to digest and present to the Subcommittee. If the Work Groups do not succeed in bringing clear understanding of issues to the Subcommittee, the Subcommittee will be unable to present it to the community in a manner that is logical. Kowetha Davidson: action item for the PHAWG is to study the issue of the screening level for radiation and to bring a report back to the Subcommittee at the next meeting and make a decision on how they want to handle it.

Unfinished Business/New Business/Issues/Concerns

Peggy Adkins requested additional information from Dr. Hershman concerning any available research on the effects of multiple exposures, including I-131, on the thyroid. Also, requested the contact information of Dr. Gregory Brent, a colleague of Dr. Hershman, who is an expert on how environmental toxins effect the thyroid. There was much discussion about whether this information should be requested of Dr. Hershman directly by Peggy Adkins or an appointed source from the Subcommittee. The information will be provided to Peggy Adkins as requested.

Identification of Action Items

ACTION 1:	Theresa NeSmith will provide the ORRHES with a copy of a representative ATSDR Needs Assessment prepared for another site.
ACTION 2:	The Communications and Outreach Work Group will work closely with Lorine Spencer of ATSDR to develop CI (community involvement) aspects of the work of the ORRHES.
ACTION 3:	The chair of the Communications and Outreach Work Group will schedule a workgroup meeting.
ACTION 4:	The Public Health Assessment Work Group (PHAWG) will determine whether there is a need and the best way to present again to the ORRHES the recommendation that the PHAWG made to the ORRHES on October 22, 2002 regarding the magnitude of the ATSDR screening level for radiation exposure.
	The recommendation presented by the PHAWG to the ORRHES on October 22, 2002 is reproduced below: RECOMMENDATION: Bob Craig reported the following recommendation from the Public Health Assessment Work Group. The Subcommittee should remain silent on the issue of the magnitude of the ATSDR screening level for radiation exposure. This recommendation received a motion, was seconded, and was not passed by the Subcommittee by a vote count of 8 in favor and 7 opposed.

Housekeeping Issues and Closing Comments

The next ORRHES meeting is February 10, 2003.

The meeting was adjourned at 5:00 PM.

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