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Internet resources for what you need to know about NYC Health
Five Favorite Sites For Beginners

The Topic
"Health" refers to the health issues facing the city, touching on everything from the mayor to Medicaid to managed care to mosquitoes.
The Context
New York City is one of the biggest public health challenges in the world. With 7 million residents--over 1 million of whom are uninsured--the city has the largest number of HIV cases and the largest number of intravenous drug users in the U.S. Efforts to contain a tuberculosis outbreak that threatened the city in the 1990's have been a major success--between 1992 and 1998, the deadly multi-drug resistant cases of TB declined by over 90 percent.

New York City has 20 public hospitals which served 1.5 million people in 1998 alone. Run by New York City's public Health and Hospitals Corporation, the hospital system now has a surplus of $21 million, following years of deficits and cutbacks.

The Reporter
Maia Szalavitz is author, with Dr. Joseph Volpicelli, of "Recovery Options: The Complete Guide: How You and Your Loved Ones Can Understand and Treat Alcohol and Other Drug Problems." She writes frequently on health, science and public policy for the New York Times, New York Magazine, the Village Voice, and other publications.

by Maia Szalavitz

In The News: The West Nile Virus

(aug-sep '00) It sounds exotic and frightening -- but is West Nile virus really a threat worse than that posed by spraying gallons of toxic pesticides over densely populated areas? Did it merit the cancelation of a New York Philharmonic concert in Central Park when the virus was found in area mosquitoes, so that spraying could begin immediately? And could pesticides used against West Nile be responsible for the deaths of 11 million lobsters in Long Island Sound?

When the first accounts of West Nile infections turned up last year, the daily reporting of new cases and deaths made it seem like a dire threat. Last year, there were 62 confirmed cases and seven deaths, This year there have been no human cases according to the New York City Department of Health. But concern about the virus has grown because it is still killing birds and has been found in local mosquitoes, which pick it up from the birds and can spread it to people.

On July 31, Mayor Giuliani and New York City Health Commissioner Neil Cohen released a statement announcing additional spraying on Staten Island. Said Cohen, "With the possibility that mosquitoes which have emerged since the last spraying effort are infected by virus-carrying birds, the City is taking the prudent course of action to re-spray the entire borough of Staten Island."

While West Nile can pose a serious threat to the elderly, to the very young and to those with compromised immune systems, these same groups are also most likely to be adversely affected by any side effects of pesticides. West Nile has no symptoms in 80% of those infected; of the 20 percent who become sick, most merely suffer flu-like symptoms. Of those ill enough to require hospitalization, 12 percent died in last year's outbreak. Those who suffer symptoms can experience brain swelling, severe headache, disturbed mental states, high fever and muscle weakness. The virus can cause permanent neurological damage in those who survive it.

The people who died last year were all over 68 years old, and three of the seven were receiving immunosuppressant therapy for cancer. One had HIV according to the Department of Health.

On the pesticide side, the "safe" Malathion that the Mayor said posed no human health risk last year is now suspected of causing cancer, though the EPA has wavered on the significance of the threat. Preliminary reports from that agency leaked to Reuters suggested it would be classed as a "suspected human carcinogen," but the agency instead released a risk assessment in May stating that in the amounts used in spraying, it is "below the EPA's level of concern." This year, New York City is using other pesticides.

But serious damage may have already been done. The New York Department of Environmental Conservation reported that malathion was responsible for the deaths of about 2,000 fish in Staten Island's Willowbrook lake last year.

And Long Island lobsterman, whose businesses have been destroyed by the deaths of the delicious crustaceans, are blaming the die-off on last year's Malathion spraying. According to an expert quoted by the New York Times, biologist Mike Loughlin, their theory is plausible. "It is well-demonstrated that a lot of these pesticides kill lobsters better than they kill mosquitoes... Almost saying the name of a pesticide will kill a lobster, they are that sensitive to some of them." More than 90 percent of the lobsters living in Long Island Sound are estimated to have died last Fall, either during or after the pesticide spraying.

Pam Hadad-Hurst, Executive Director of the New York Coalition for Alternatives to Pesticides said her organization's calls for a scientific risk assessment have been ignored. "No one has done a study to determine which is worse, the spraying or West Nile. We've had a year already; we should be trying to understand this but we still don't know."

Hadad-Hurst believes that spraying should only be done as a last resort. "We have to realize these chemicals are poisons, designed to kill living things," she says. Hadad-Hurst also points out that spraying can kill "good" insects like dragon flies, which prey on mosquitoes. Despite spraying, Staten Island's mosquito population has recently bounced back prompting yet more spraying. According to a study published in the journal, Emerging Infectious Diseases, over-reliance on pesticides may be one reason that mosquito-borne diseases like malaria and dengue fever are making a comeback in other areas of the world.

"Prevention is really the best cure," says Hadad-Hurst. "If you use bacterial larvacides [pest killers which use bacteria to eat baby mosquitoes], teach people to avoid getting bitten and to remove standing water, encourage natural predators like bats and dragonflies-- all of this can help."

There is some good news as well, which may shift the balance in the risk assessment. A recent study published in the Journal of Infectious Diseases found that the drug ribavirin, currently used to treat Hepatitis C, may also work against West Nile virus. The study is very preliminary and is based only on test tube trials, not results in humans or even animals. But if effective medication is found for the currently untreatable disease, this could make the need for pesticide use to combat its spread far less compelling.

Maia Sounds Off:

Pesticides can have long-term effects on the environment as well as on human reproduction, cancer risk and human endocrine functioning. These chemicals can cause damage to children, to fetuses and to our hormonal balance. Without a proper scientific risk assessment of the dangers posed by pesticide use and the dangers posed by endemic West Nile virus, the region's public health and environment may be at risk.

The unintended consequences of decisions made with good intentions are well known-- why pave the road to hell when we could learn about alternate routes elsewhere? The die-offs of lobsters and fish are already costing millions of dollars as well as fishermen's jobs.

A study of the risks and benefits of pesticide use in the prevention of West Nile virus would be the best investment we could make in dealing with the crisis. At least that way, the public and politicians could start on the same page when arguing whether or not to spray or take other preventive measures. In the meanwhile, the use of natural predators like dragonflies and bats should be considered.

Maia's Favorite Five Sites For Beginners:

  • New York City Department of Health - Includes health alerts (including West Nile info), information on restaurant sanitary conditions and information on various health-promotion programs.
  • New York State Department of Health - More health data for New Yorkers including information on how to sign up for Child Health Plus and Family Health Plus-- the insurance programs for those who are presently not covered by other plans.
  • Medscape - This site, aimed at doctors, allows you to search Medline, the database of medical journals, for free. Abstracts of most journal articles are available for free as well. Once you have some basic knowledge about a condition you are researching, you can look here to get a sense of what is going on in terms of study in the area. There is a companion consumer-focused site, CBSHealthWatch, which is linked.
  • American Cancer Society - Half of all Americans will face cancer at some point in their lives-- and the New York and Washington-based American Cancer Society web site provides a wealth of information for those dealing with the disease. Includes links to other major cancer sites and resources.
  • AIDS Information - A sort of "AIDS central" for New York city with links to major HIV/AIDS organizations and information sites.

Other Recommendations:

  • Quackwatch - Debunks medical scams and inflated claims made by "alternative" medical practitioners.
  • - A consumer health information site, affiliated with CNN.
  • Citizen Action - Healthcare is one of the primary focuses of this New York advocacy group. Includes information on New York's health plans for low income people lacking insurance.
  • Oncolink - An incredible research resource for cancer patients and others concerned about this disease.
  • National Alliance for the Mentally Ill - An organization of advocates for people with mental illness which includes information on treatment and support for various disorders like depression, bipolar disease and schizophrenia.
  • Insure Kids Now - Information on New York state's insurance program for poor kids and information on other state's policies, from the federal government and the governors' association.

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