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Agenda- 21 June 2002
COMMITTEE ON THE MEDICAL EFFECTS OF AIR POLLUTANTS Minutes of the meeting held on Friday 21st June 2002 in Room 125A, Department of Health, Skipton House, 80 London Road, London SE1 6LH.
ITEM 1. OPENING REMARKS, APOLOGIES FOR ABSENCE AND ANNOUNCEMENTS 1. Apologies for absence were received from Professor Dafydd Walters, Professor Peter Blain, Lord Toby Harris, Nigel McMahon (assessor) and Mr Peter Ridgway (HSE). 2. The Chairman congratulated Professors Seaton, Anderson, Harrison and Richards on the extension of their appointments as Members of COMEAP for a further year. 3. The Chairman also welcomed Dr Elkabir, a respiratory physician who was attending with Dr Murray as an observer; Mr Allyn Jones (HSE) and Mr Richard Harris (DTI) who were attending for the discussion of Item 5; Dr Olivia Carlton and Dr Chris Beach (London Underground) who were attending for Item 4; Professor Dick Derwent (Meteorological Office) who was attending for Item 6 and Mr Glen Clarke who was attending as part of the Secretariat. 4. The Chairman informed Members that the following changes had been made within the Secretariat: Claire Townsend had left, Julia Cumberlidge would still attend meetings but as she had taken on other work for the branch, would hand over the scientific support work and minute taking to Isabella Lindup. Emma Jenkins would be overseeing the administrative support to COMEAP. 5. The Secretariat informed Members that Mr Robert Waller, a past member of the COMEAP and MAAPE Secretariat, had died. The Secretariat provided a short obituary and requested that the Chairman write to Mr Waller's widow on behalf of the Committee to express their condolences and appreciation for all his previous work for the Committee. [ACTION: Chairman] 6. The Secretariat informed Members of the difficulties which had occurred regarding payment of Members' claims. Accepting that most Members' claims had now been paid, it was requested that those who were still awaiting payment should contact the Secretariat. [ACTION: Members] 7. The Secretariat reminded Members of their entitlement to claim reading fees, although it was highlighted that these could not be claimed retrospectively if expenses for that meeting had already been submitted. Members' attention was drawn to tabled expenses claim forms, tax exemption form and explanatory notes. 8. It was noted that the following changes needed to be made to the meeting minutes:
[ACTION: Secretariat] 9. Subject to these amendments, the minutes were agreed as an accurate record of the meeting. 10. The Secretariat noted that most of the minutes could be made publicly available on unflued gas fires except some paragraphs of the minutes which contained commercial -"in-confidence" information. HSE and DTI agreed that full meeting minutes could be made available once a statement had been provided by the Committee and the report considered by the Committee had been published. [ACTION: Secretariat] ITEM 3. MATTERS ARISING 3.1 Statement on Particles and Cardiovascular Disease 11. The Chairman confirmed that the statement had been placed on the COMEAP website along with all supporting papers. 3.2 Cardiovascular Sub-Group 12. The Secretariat informed Members that there had been a delay in the progress of the report currently being written by members of this group. This was due to a surge in publicity on asthma and air pollution from the publication of the Venn and the McConnell studies and the subsequent establishment of a sub-group on asthma and air pollution (see below). Members were informed that the cardiovascular report is due for publication by Easter 2003 and the Secretariat would welcome contributions over the summer period. Professor Jon Ayres who chairs this sub-group informed members that he had posted information to Members on the Cardiovascular Sub-Group's website. 13. Professor Poole-Wilson stressed the importance of this sub-group and suggested that COMEAP would benefit from having more cardiovascular specialists on the Committee. 14. It was suggested that this could be considered next year when a further set of appointments to COMEAP arise. 3.3 Committee Openness 15. The Chairman informed Members that this item had been deferred until the next meeting. 3.4 Biographies and Glossary 16. Members' biographies were tabled and it was requested that Members contact the Secretariat if amendments were required. 17. Members were informed that the glossary was being compiled and would
be sent out to Members for comment before subsequent placement on the
COMEAP website. [ACTION: Secretariat] 3.5 Annual Report 18. The Secretariat informed Members that the final parts of the Annual Report for 2001, including the Register of Interests and Glossary, would be circulated for final checking by Members. 19. The Secretariat requested that when Members are required to submit
'Members' Interests' that a fresh list be submitted, irrespective of whether
their previous submission had changed or not. [ACTION: Members] 20. The Secretariat also informed Members that an annual report for 1999/2000 was still to be completed. [ACTION: Secretariat] 3.6 Air Pollution - What it Means for Your Health 21. The Secretariat provided comment from a recent meeting with a focus group in Birmingham, which had discussed the leaflet. The consensus was that the health content of the leaflet was quite basic and that the public would be interested in more detailed information. In light of this, the Secretariat proposed creating a new leaflet in conjunction with the updating of the Department of Health's Air Pollution Handbook. 22. COMEAP Members and in particular, Mrs Lambert, will assist the Secretariat in creating the leaflet. Professor Seaton suggested that a GP should also be consulted for comment. [ACTION: Secretariat]
23. Mr Hurley declared that he had been involved in a project for London Underground in the past. 24. It was confirmed that most Members were generally happy with the Statement. However, some Members felt that the Statement did not go far enough in confirming that the dust was unlikely to have much of an effect on health. 25. The Committee discussed whether they were to assess overall risks to health pertaining to London Underground dust or simply to provide comment on Dr Hawkins' report. The Secretariat emphasised the latter since the report was the only material presented to the Committee. 26. London Underground was asked to confirm that this is what is required. [ACTION: London Underground] 27. Members disagreed with the last sentence of paragraph 2 of the draft Statement as certain aspects of the risks from the dust could be assessed (e.g. risks from silicosis) (see below). 28. In paragraph 3, the London Underground representatives pointed out that it was incorrect that 'no cases of occupational lung diseases had been detected amongst employees of the London Underground' since some cases of asbestosis had been found in employees working in the workshops. However, these employees did not have high exposures to tunnel dust. 29. Members pointed out that what had actually been discussed was the reassuring lack of cases of silicosis (rather than occupational lung disease in general) suggesting the presence of quartz in the dust was not a major problem. (However, it was also noted that workers were more concerned about PM10 and iron, than quartz). 30. In discussing paragraph 4, Members were unable to say for certain whether they thought tunnel dust was less toxic than that found in ambient air, but they confirmed that tunnel dust was different to dust found in ambient air. 31. Members noted that they had, in their earlier statement, recommended that an epidemiological study of the effects of London Underground tunnel dust on health be undertaken. Members agreed that if this suggestion were to be taken up, workers should be studied. Workers in the London Underground would inevitably experience greater exposure to tunnel dust than the travelling public and thus a lack of effect in this group would be reassuring to the general public. 32. It was also suggested that the statement could be re-organised by bringing 6(ii) up to join paragraph 2 and to put paragraph 4 before paragraph 3, so that the discussion of health effects in workers led on to the point in 6(I). 33. It was concluded that the statement would be redrafted and agreed through correspondence with the Members.
No interests were declared in this item. Public Availability: It was further noted that paragraphs 34-43 should not be made publicly available at the present time since these paragraphs referred to work that was currently in progress and not in the public domain. 44. It was concluded and agreed by HSE and DTI that the statement would be redrafted and agreed through correspondence with the Members. [ACTION: Secretariat]
RECENT TRENDS IN OZONE CONCENTRATIONS ACROSS THE UK 45. The Chairman welcomed Professor Dick Derwent and congratulated him on the acquisition of his Professorship from Birmingham University. 46. Professor Derwent took the Committee through the paper he had written for COMEAP as background information for the Committee's subsequent discussion on Ozone. He highlighted a number of issues:
47. The Chairman alerted Members to the tabled Addendum 2002/9a which provided comments on the paper Wong et al 2002. 48. Dr Heather Walton introduced the paper and acknowledged the contribution made by Professor Anderson and his team by providing output from the database. 49. Dr Walton informed the Members that this paper was to be considered as work in progress. For example, plots of coefficients against mean ozone concentrations had yet to be produced. 50. The Committee discussed the following:
51. A point was made that future statements on the effects of Ozone:
52. It was noted that the percentage change in respiratory mortality was not sufficient to account for the percentage change in all cause mortality and effects on cardiovascular mortality could account for this difference. 53. It was agreed that, although the one hour average and 24 hour average data could not be combined with 8 hour average data, the effects using these averaging times should be examined. 24 hour average data were not a good reflection of the effect of peaks but might provide some insight into the effect of a slow increase in overall average levels. 54. Further work on seasonal differences was agreed. Seasonal comparisons were considered more powerful within the studies rather than between studies. Higher, more variable levels in summer were being compared with lower less variable levels in winter. What was wanted was an insight into higher, less variable levels in the future. Interpretation of differences was complex. For example, asthma admissions were low in summer (when Ozone levels were high) due to fewer virus-related exacerbations when children were not at school. 55. The Committee concluded that there was sufficient evidence to support an effect on some health outcomes and therefore to justify further work in this area. It was suggested that it would be productive to look at publication bias and to consider the change in coefficients according to date of publication and whether the size of the coefficients was dependent on the mean ozone concentration in the relevant city. It was also suggested that a scoping study considering how much it mattered whether or not there was a threshold at a particular level would be helpful. A further paper on this, in addition to the deferred long-term effects paper, would be considered at the next meeting. [ACTION: Secretariat]
56. The Secretariat introduced the two papers which were published earlier this year and which attracted much media attention. A summary was provided of all comments received by the Secretariat from COMEAP Members on these papers and a draft statement written. The Secretariat asked Members to comment on the statement and the following points were discussed: McConnell
57. It was concluded that it was not reasonable to deduce from the two papers that air pollution caused healthy people to develop asthma and that the statements would be redrafted and agreed through correspondence with the Members before being put on the COMEAP website. [ACTION: Secretariat]
58. The Secretariat introduced this item and provided members with the relevant history. Members' attention was drawn to Annex III which summed up the present position of the sub-group and Annex IV which contained a review paper by Professor David Strachan. Members were informed that the first meeting of the sub-group would take place on the 3rd July 2002 and that they were proposing to produce a 30 page report by Christmas 2002 on whether air pollution played a role in the causation of asthma. The Chairman of the sub-group committee, Professor Jon Ayres, confirmed that he would provide Members of COMEAP with an update at the next meeting. 59. Correction requested to Annex 3 Paragraph 1 line 4 add 'Meacher'
60. The Secretariat informed Members that of the original 70 proposals received in response to the Department of Health's call for proposals for research into air pollution and health, 38 were sent out for peer review. Responses from some reviews had taken longer than expected, hence the slight delay in final decisions being made. In the final sift, decisions were made based on scientific quality, policy relevance and value for money. Several good proposals had to be turned down due to insufficient funds. However, nine (9) proposals were chosen, for which total funding amounted to just over the £1million allocated. 61. The Secretariat informed Members that letters had been sent to researchers on whether they had been successful or unsuccessful. The results of the selection would soon be publicly announced.
62. It was suggested by The Secretariat that as part of their duties to COMEAP, Members should attend the Annual Meeting held at IEH in Leicester. It was envisaged that attendance would provide the opportunity for COMEAP Members to keep themselves informed about recent research, research in progress and research funded by bodies other than the Department of Health. 63. The Secretariat informed Members that full expenses would be reimbursed
and that an attendance fee would be granted for attendance at this meeting.
It was requested that Members confirm whether they agreed with this being
a compulsory duty at the next meeting of COMEAP. [ACTION: Members]
9.1 COMEAP 5 Year Review 64. The Secretariat informed Members that Dr Jeremy Metters CB, a retired DCMO had agreed to perform this task which would commence at the end of the year. 9.2 Use of Generalised Additive Models (GAM) in Time-Series Studies 65. Professor Anderson drew Members' attention to a brief paper on this topic, which had been tabled. The paper alerted Members to a cautionary note from NMMAPS workers in the US that had been placed on the John Hopkins' website concerning a problem which had arisen with the time series regression analysis technique and the use of GAM in the statistical programme 'S plus'. Due to the default criteria in one particular part of the calculations not being sufficiently stringent, this in some cases resulted in an upward or downward bias in the coefficients. 66. Professor Anderson informed Members that this did not have repercussions on the APHEA group study, as when their PM10 and mortality or hospital admissions data were re-analysed using the new criteria, there was little change in the results. The NMMAPS PM10 and daily mortality data was halved as a result of correcting these default criteria. There are studies using methods of analysis other than GAM and these still show clear positive results. 67. Professor Anderson told Members that he would have a clearer view of what was happening and the repercussions by the next meeting of COMEAP and would provide an update. However, he concluded that this situation should not effect any of the decisions previously made by COMEAP in the short term. [ACTION: Professor Anderson] 9.3 Health Protection Agency 68. Members were alerted to a consultation document which had been tabled. 9.4 CO 69. The Secretariat brought to Members' attention a video on Carbon Monoxide (aimed at medical professionals) and requested that Members take a copy. 9.5 Useful Books/Papers/Reports 70. Dr Paul Harrison of IEH informed Members of a useful report on population
exposure to PM2.5 9.6 Other tabled items
71. Dates for the next two meetings were confirmed as:
72. Both meetings are to be held at Skipton House. The Secretariat
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