40 20 10 20 Oxidant (pphm) Ihr Defore r-62 20 40 60 Particulates (Km x 10) 10 20 30 Oxidant (pphm) 1 hr before r-.08 Carbon monoxide (ppm) 2. Correlations between selected pollutant levels and the percent of team members whose performance decreased compared to that in the previous home meet (pphm signifies parts per hundred million). in individuals on the team could be responsible. Comment Becaus improvement in performance is somewhat vas to accomplish early in the season, a tend or the days with high pollution to con late the season could produce a spurious posttive correlation. Days with high pollution, how ever, appear to be scattered randomly through.** the two-month cross-country running season 1 each cf the six years. For example, in 1962 the worst pollution was during the first meet, whereas in 1963 the highest level was reached in the sixt. meet. Futhermore, the average pollution level for meets held in the first half of the season is almost identical to the average for the last half. A bias also might result if the opposing team were the same on days of similar pollution; however, this was not the case. 10 20 Oxidant (pphm) hour before meet 30 3. Oxidant level in the hour before the meet by percent of team members with decreased performance. An attempt to identify individual runners who were particularly susceptible to the effects of air pollution was unsuccessful. Careful examination of the team roster for each year indicated that none of the boys were consistently affected when they ran on heavily polluted days. Nor was there any tendency for the runners whose performance decreased to come from any particular school grade; seniors were affected as often as sophomores. Actually, this finding is not surprising since a boy whose performance drops at one meet may be strongly motivated to do well in succeeding meets. Also, any boy who showed frequent decreases in performance would hardly be desirable on a competitive team. If the observed marked association of oxidant levels were for less specific measures of pollution, such as daily averages, then an explanation other than that oxidants were directly causal inight be plausible. For example, other variables such as day of the week might be related to both performance air pollution. Our results, however, indicate the relationship is app rently limited to the dont level in the hour lefore the race. This specificity to a biologically meaningful time and the extremely high correlation (r=0.95) are convincing evidence tha: some omponent of the air which is measured as oxidant has a causal effect on team performance. That a long-range, chronic effect of air pollution is not also operative can not be inferred, since the study was designed to detect immediate effects only. The level of oxidant in the air reflects the con centration of a number of specific compounds including ozone. The exact mechanism by which one or several of these components affects performance is not clear. Smith' claims that athletes require more oxygen during exercise when they breathe air polluted with one of the oxidant components, peroxyacetyl nitrate (PAN). His observed difference in oxygen consumption, however, is small (2.3% increase). In addition, his failure to describe adequately the experimental design and statistics used makes the results essentially uninterpretable. Ozone at levels several times higher than those usually reached in Los Angeles seems to have some effect on pulmonary function." That breathing some of the oxidant compounds might cause an increase in airway resistance and hence an increase in work of breathing is not unreasonable. Maximal exertion in healthy boys, especially at sea level, however, is not limited by ventilation or work of breathing. Thus, it seems unlikely that the observed effect of oxidants on performance is due to decreased availability of oxygen. Oxidizing pollution is definitely irritating to the eyes, and athletes often complain of chest discomfort after exercising in the Los Angeles area on days with high pollution. Thus, the observed effects may be more related to lack of maximal effort due to increasing discomfort than directly to physiologic capability. Determination of exactly how oxidants affect performance in these athletes is of great importance. For example, the relevance of these results to patients with borderline cardiac competence or chron ic lung disease is completely different if the effect is directly on physiologic mechanisms such as ventilatory capacity rather than secondarily through an effect on motivation. Careful studies of pulmonary function and oxygen debt incurred during a race might help clarify the issue. Analyses of other types of athletic events requiring less ventilation and less aerobic metabolism are also needed. Our results should not be interpreted as representing an effect of air pollution in general, since a predominately oxidizing type of pollution is not present in most cities. Repetition of the study is necessary in situations where oxidant pollution is not present. Care should be taken to be sure that oxidants are really nonex tent, however, as high levels of common pollutants such as sulfur dioxide can interfere with the usual tests for oxidants and give a false zero level.' This investigation was supported in part by US Public Health References 1 Smith, LE: Peroxyacety! Nitrate Inhalation, Arch Environ Health 10:161-164 (Feb) 1965. 2. Hallet, W.Y.: Effect of Ozone and Cigarette Smoke on Lung Function, Arch Environ Health 10:295-302 (Feb) 1965. 3. Young, W.A., et al.: Effect of Low Concentrations of Ozone on Pulmonary Function in Man, J Appl Physiol 19:765-768 (July) 1964. 4. Mitchell, J.H., et al: The Physiologic Meaning of the Maximal Oxygen Intake Test, J Clin Invest 37:538-547 (April) 1968. 5. Saltzman, B.E., and Wartburg, A.F.: Absorption Tube for Removal of Interfering Sulfur Dioxide in Analysis of Atmospheric Oxidant, Anal Chem 37:779-782 (May) 1965. Fee Increased Radiology Board Sets Written Examination The following change in policy and procedures of the American Board of Radiology was received too late for inclusion in the Nov 21, 1966. Education Number of THE JOURNAL. It is published here for the attention of all physicians concerned with specialty certification by the American Board of Radiology. The American Board of Radiology wishes to announce the institution of a written examination to be given for the first time during the latter half of June 1968. This is to be given in various centers over the country, and all residents having completed three years of approved training as of June 30, 1968, will be eligible to take the examination. Passing of the written examination will be a prerequisite to taking the oral examination. The fourth year of further training or practice presently required will still be mandatory. Applications for the written examination or either of the oral examinations (June or December) in any given year must be filed before Jan 1 of the year in which the examination is given. The present examination fee of $150 will, as of July 1, 1967, be increased to $200. This fee, however, will cover both the written and oral examinations where both are required. Candidates eligible for the oral examinations in June 1968 will not be required to take the written examination. All reexamination fees will be increased from $75 to $100 as of the above date. The December 1967 examination will be held at the Statler Hilton Hotel, Dallas, Dec 4-8, inclusive; the deadline for filling applications is June 30, 1967. The June 1968 examination will be held at the Fontainebleau Hotel, Miami Beach, Fla, June 10-14, inclusive; the deadline date for filing applications is Dec 31, 1967. Deadline for filing for the written examination in June 1968 or the oral examination in December 1968 is Dec 31, 1967. Mr. MULTER. Does your last reference refer to the bill, H.R. 12232? Have you seen that bill? Dr. KAILIN. No. I was referring to H.R. 6981. Mr. MULTER. You might look at that bill and then send us a supplemental statement to indicate your thoughts as to whether that is covered by your statement. If you want to add anything to your statement with reference to that bill, you may do so. Dr. KAILIN. Thank you. Mr. MULTER. Any questions? Mr. WINN. Dr. Kailin, has the District of Columbia Medical Society run any tests? Dr. KAIILIN. Tests? No. Surveys? Yes. Mr. WINN. What do you mean by surveys? Dr. KAILIN. I was here last Thursday. I heard your questions. Dr. KAILIN. I decided to do something about it, sir. In the last two days I have sent out 172 questionnaires. We handled it this way. I placed 16 questionnaires in an office, a member of one of my family in Suitland, Maryland. The question that we asked was, "Do you believe that air pollution causes eye irritation? Does it actually occur or do you believe it occurs?" So it is not a measurement of a physiological thing. With this approach of the 16 subjects, ten reported that in some circumstances air pollution did irritate their eyes. We asked a little bit further questions. "Is this only under special circumstances, such as being behind a bus or in a parking garage, or is it true of a more general area." 75% of the group, 12 of the 16, had symptoms under some circumstances. 44% of the group found-7 of the group told us they did have eye irritation in a more general area. We took 24 questionnaires asking the staff of a cancer clinic, at 23rd and Pennsylvania, these other nurses, the secretaries, the technicians, the medical students, the doctors, of those 24 people 15 in all felt that air pollution affected their eyes under some circumstances and 11 of them felt that the air in general on at least several occasions a year bothered their eyes. Mr. MULTER. Without objection, copy of your questionnaire will be included in the record. (The document referred to follows:) QUESTIONNAIRE SURVEY OF EYE SYMPTOMS Question: The D.C. Medical Society would like to know whether people feel that air pollution in the Washington Metropolitan area at times has an irritating effect on their eyes. I. Have you felt such irritation in the last 12 months? A. Not at all. B. On one to three occasions C. Four or more occasions II. If you have noticed such irritation, do you associate eye irritation with: C. In the suburbs of Washington on a smoggy day? III. Do you know other people who live or work near you who have complained that air pollution irritates their eyes? IV. Do you have an allergy to anything that affects your nose? Of the 52 persons in all of the above groups who reported nasal allergy, 43 or 83 percent attributed eye irritation to air pollution under at least some circumstances. Mr. WINN. Not being a doctor I cannot get the tie between cancer and checking people's eyes. Why were you asking people in a cancer clinic about eyes? Just a place to poll people? い Dr. KAILIN. A place to ask people working in a downtown area and because one of my colleagues works there. My own office staff and people dropping in the office, people without allergies, just people coming in-we found again 45% of these people had eye irritation in a general area and about 66% complained about eye irritation when it included heavy spot exposure such as behind a bus. Mr. WINN. Are you an eye doctor? Dr. KAILAN. No I am an allergist. We did a telephone survey. We just picked names out of the D.C. telephone directory and we reached 89 people. 63 Percent of those people had symptoms under the whole spectrum of possible circumstances. Mr. WINN. What question did you ask them on the telephone? How did you pose the question? Dr. KAILIN. The D.C. Medical Society would like to know whether people feel that air pollution in the Washington metropolitan area at times have an irritating effect on their eyes. Are you willing to answer four questions? First, have you felt such irritation in the last 12 months, not at all, one, two, three occasions, four or more occasions? And then, if you noticed such irritation did you associate it with a special location such as being behind a bus or in a parking garage; being almost any place in downtown Washington on a smoggy day; being in the suburbs of Washington on a smoggy day? Mr. WINN. Was there a difference between downtown Washington and the suburbs in your percentages? Did pollution or irritants seem higher downtown. Dr. KAILIN. I couldn't answer that question. I will know more when I go over the data again. But many of these people never went into the suburbs. If we went back over our data and searched a little deeper I had one person who said she had trouble in Washington once but she almost never goes into Washington. The one day she went in she had trouble. Mr. WINN. Anything further you can give us on that will be appreciated. Dr. KAILIN. On our telephone survey we also found half the people complained of eye irritation from the general air. Among allergic persons it runs much higher, If we select the persons who told us they had an allergy in their nose, 83 percent of them have some symptoms under some circumstances. Mr. WINN. These are people who had known allergies? Dr. KAILIN. Yes. I did not include persons who got hives after a bee sting, for instance. Mr. WINN. These people were more aware of air pollution than a person that does not have an allergy? Dr. KAILIN. Yes. Mr. WINN. What percentage of the general public have allergies? Dr. KAILIN. I think it is going to run around 20%. Mr. WINN. Twenty percent of all of us have some type of allergy? Dr. KAILIN. Yes. Pretty close to it. There have been a number of surveys. This is going to hit pretty close to that. Mr. WINN. Thank you very much. Mr. GUDE. You said one part of your survey was just a random selection out of the telephone book. Then it was not confined just to persons with allergies." Dr. KAILIN. This was a random selection of telephone numbers from the telephone book. Mr. GUDE. What were the results of your random poll? Dr. KAILIN. Of that group 51.7 percent felt that the general downtown area was irritating to their eyes and 63 percent felt both the general area and special circumstanes, like being in a high pollution area behind a bus or in a parking garage, was irritating. Mr. GUDE. Now as to specific data. You stated on line 7, "aggravation of asthma attacks have been reported by some research workers at about the same low does level. Other researchers report asthma attacks at the level associated with eye irritation, or 9.15 parts per million of .15 parts per million. A value of .15 parts per million was exceeded on ten days in 1965." So these are specific figures that you researched? Dr. KAILIN. Yes. Those are people's surveys, not made in Washington. " Mr. GUDE. But the .15 apart from being a sulfur dioxide— Dr. KAILIN. That was oxidants. Mr. GUDE. Whether it occurred in Washington or any other area, this would hold true for an asthmatic regardless of which city he lived in? Dr. KAILIN. That is right. Mr. GUDE. This is a constant. Dr. KAILIN. It is a constant for a particular site. I think that Mr. Wynn has already indicated that a measuring device only measures the air where that device is. This is correct. I have a person over in Bethesda. Is it .15 where he is or does it happen to be much more? This is one of the difficulties of doing research in this field. Mr. GUDE. But you do know that when .15 is present, asthma patients will have more difficulty than they will in areas where there is less than .15? Dr. KAILIN. That is what the survey indicates so far. |