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The First Three Years: Review of 484 Cases
As previously noted, more than 500 men and women who were exposed to World Trade Center contaminants have completed the detoxification program. This report summarizes a recent review of medical folders from the 484 men and women who enrolled in the program between September 2002 and September 2005: 273 firefighters, 52 sanitation workers, 19 paramedics, 23 police officers, and 117 others. Of these, 63 individuals left the program prior to completion. These results indicate a range of benefits that sum up to improved quality of life and job fitness. The number in each test sample varies to some extent. Certain tests were added or changed as the project evolved, and therefore not all tests were performed on all clients. Results are described only for those individuals who had multiple data points on that test. Emphasis has been placed on the findings of greatest interest.

A. Healthy Days and Job Fitness
Three core questions from the CDC Health-Related Quality of Life instrument are included in the structured health history and symptom survey. These quantify the number of days physical and mental health was not good, as well as how many days poor physical or mental health kept each individual from doing their usual activities, such as self-care, work, or recreation. These were completed by all clients who underwent detoxification after June 2005.

• Prior to enrollment individuals averaged 4.4 days of limited activity and 2.1 days missed work per month.
• After detoxification, these individuals reported 0.2 days of missed work or limited activities – this includes the month they underwent therapy. (See Figure 1: Improvement in Health-Related Quality of Life, a 101KB .pdf)

A majority of rescue workers seeking detoxification treatment are concerned that their health problems might force them to leave their jobs. The majority of these individuals are between 35 and 45 years of age (ranging from 20 to 77 years); many have young children. While forced retirement of these men would be costly to the city, the disability benefits that each individual man might expect are not sufficient to support a family. Thus, anxieties about health are compounded by financial concerns and further complicated by a determination to continue on the job without mentioning symptoms.

B. Symptom Severity
The Health History and Symptom Survey consists of 50 items on ten scales for systems commonly impacted by chemical exposure and is used to assess changes in symptoms over the course of sauna detoxification. Responses are normalized to take into account the fact that there are different numbers of questions per category of symptoms. Improvements on all symptom scales—manifestations consistent with exposures to the range of toxicants known to be released at the WTC site—were especially strong. (See Figure 2: Change in Symptom Severity with Detoxification, a 105KB .pdf.)

C. Need for Medication
The case review revealed that almost half the individuals were taking as many as 16 medications to relieve their exposure symptoms. At program completion, 84% of those clients no longer required medication because their exposure symptoms abated. Of the seven percent still taking medicine, use was reduced to only a single medication in most cases. As these symptoms abate, clients are able to reduce and ultimately eliminate the medications they are taking. (See Figure 3: Change in Use of Medications with Detoxification, a 44KB .pdf)

These clients work in professions that require a high level of fitness. Those who had been on medications for an extended period experienced the side effects as unwelcome (if not dangerous) impediments to both their accustomed state of well-being and their job fitness.

D. Vestibular Function
Impairment of vestibular function is associated in the literature with toxic exposures.^34,35 The postural sway test is a sensitive and reliable method of measuring balance developed for field use measuring the mean speed along the path moved with eyes open and when eyes are closed.²³ Pre/post detoxification balance testing was completed on a random cohort of firefighters exposed to WTC toxins. There is a statistically significant difference (p = 0.12) between sway test results before and after detoxification, with the pre-detoxification measurements significantly impaired, as demonstrated by increased sway speed, compared with predicted results of reference populations (see the "zero" line in Figure 3).

Balance is crucial to firefighters. If balance is impaired, a firefighter may not be able to remain upright in a dark area. Following detoxification, the exposed firefighters have sway test values that approach those of an unexposed reference population. (See Figure 4: Change in Balance Test, a 97KB .pdf.)

E. Reaction Time
Impairment of Choice Reaction Time (CRT) has been previously shown in firefighters exposed to PCBs.^21,32 CRT testing measures cognitive function: vigilance, discrimination, and speed of reaction (abilities that are obviously crucial to firefighters, police, or paramedics). Pre/post detoxification CRT testing was completed on a random cohort of firefighters exposed to WTC toxins.

Firefighters have faster than predicted measures of both Single Reaction Time (SRT) and CRT, as seen in the negative variance from predicted results. The improvement in CRT following detoxification is statistically significant (p < 0.1) and suggests improvement in cognitive function. (See Figure 5: Change in Reaction Time With Detoxification, a 92KB .pdf..)

The findings of neurologic improvement are consistent with improvements noted in earlier detoxification studies involving firefighters.²¹ Following a transformer fire in Shreveport Louisiana, 17 firefighters with a history of acute exposure to polychlorinated biphenyls, dibenzofurans, and dibenzodioxins underwent neurophysiological and neuropsychological tests. Prior to detoxification, five of the 17 had abnormal current perception threshold measurements. Following therapy, all showed improvement with two clients returning to normal range. In this same study, firefighters had improved scores on memory tests, block design, trails B, and embedded figures. These findings raised the possibility that damage heretofore thought to be permanent may in many instances be partially reversible. It is interesting that in these smaller studies, vestibular and reaction time results were not observed.

F. Intelligence Quotient
Reduced IQ can be a result of toxic exposure and has significant economic impact.^13,15 All clients completed Novis Intelligence Quotient tests before and after participating in the detoxification program. Clients complete a different version of this test on each testing occasion, therefore improved test scores are not a reflection of learning.

While there is no data on the IQ levels of exposed workers prior to exposure, the measured average increase of almost four points of IQ following detoxification is statistically significant over that measured prior to therapy (p < 0.005) and may suggest restored cognitive function.

G. Blood Cholesterol
Lipoprotein profiles are a predictive factor for atherosclerosis and coronary heart disease.⁵³ Low density lipoprotein (LDL-C) carries cholesterol from the liver to the cells where it is used. If supply exceeds demand, excess LDL-C can cause harmful build-up of cholesterol along arterial walls. High density lipoprotein (HDL-C) helps reverse cholesterol transport, prevents endothelial dysfunction, and contains anti-inflammatory, anti-oxidant, and antithrombotic properties. Lipoprotein profiles can be adversely affected by chemical exposure.³

• Before therapy, 14% of clients had total cholesterol above 240 mg/dL with 50% above 200 mg/dL. LDL-C was above 130 mg/dL in 30% of clients, and HDL-C was below 40 mg/dL in 19.5%.
• Following therapy, over 70% had total cholesterol and LDL-C levels in the desirable range. LDL-C remained above 130 mg/dL in 11.6% of clients, and HDL-C was below 40 mg/dL in 12%.

H. Thyroid Function
Over the last decade, a growing body of research has associated a range of adverse endocrine effects with toxic exposure, including thyroid effects.⁴⁹ Exposure to toxic metals, chemical poisons, and a number of drugs can also influence the peripheral fate of thyroid hormones.¹⁸

• Thirty percent of all clients in this group have abnormal levels of thyroid-related hormones at the start of therapy.
• Following therapy, 66% of those who had elevated levels now have normal thyroid function with the remaining third improved.

As a group, average thyroxin levels are within the normal range, though at the high end at enrollment. A statistically significant trend exists for the lowering of thyroxin levels during the detoxification process.

Pituitary production of thyroid stimulating hormone (TSH) is an early indicator of compromised thyroid activity. When the thyroid gland becomes inefficient, as in early hypothyroidism, the TSH becomes elevated even though the T4 and T3 may still be within the "normal" range. Average TSH levels in clients are elevated prior to enrollment and return to normal range during the regimen. (See Figure 6: Average Thyroid Hormone Levels, a 70KB .pdf.)

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