Considering chloramine

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For three years, dozens of Bay Area residents have alleged the water disinfectant used in San Francisco and other cities causes a variety of symptoms ranging from asthma to fainting to rashes. The San Francisco Department of Public Health has spent more than $100,000 to study the chemical, chloramine, but it has not done a full scientific study that might prove or disprove a connection between the chemical and the reported symptoms.

Responding to the lack of scientific studies on the dermatological and respiratory effects of the chloramine, Assemblymember Ira Ruskin (D–Redwood City) introduced legislation to further study the chemical, but the measure was held up in the Appropriations Committee as the June 8 deadline for advancing it passed, frustrating those who hoped to finally get some answers.

Chloramine replaced chlorine in San Francisco’s water system in February 2004 after the Environmental Protection Agency tightened regulations against trihalomethanes and haloacetic acids, chlorine by-products that may be carcinogenic. Chloramine, which doesn’t produce high levels of these by-products, is the only other distribution-system disinfectant with EPA approval. It has been in use since 1917, and 29 percent of water utilities in the United States now use it. The San Francisco Public Utilities Commission was the last major Bay Area water utility to adopt it, placing it in the water that also supplies nearby cities.

Soon after the switch, though, people began to report problems. Denise Johnson-Kula of Menlo Park said she fainted while taking a shower two days after the chemical was introduced.

"My sinuses filled up; my nose was running like a faucet… I coughed and wheezed until I could not breathe and slid down the shower," she told the Guardian. "I heard the doorbell like I was dreaming; I didn’t realize I was sitting on the bathroom floor."

After throwing out all her soap and shampoo and still having allergic reactions while bathing, she avoided the shower altogether. She still washed the dishes, though, and noticed she got rashes where the water touched her. Once she took herself completely off the water, Johnson-Kula’s symptoms went away.

She now avoids the city water altogether, spending $200 a month on bottled water and traveling more than an hour to take a shower on weekends. She started a group called Citizens Concerned About Chloramine, which claims more than 400 members and has led to the creation of similar groups in Vermont, New York, and Maine.

Other stories play out similarly. Jo Yang, 24, of Los Altos, for example, developed debilitating rashes across his body and face while drinking chloraminated water in San Diego in college. When he came home in 2005 to Los Altos, which was then using chloramine, his rashes didn’t clear up until he avoided the water. Marylin Raubitschek, 81, of San Mateo, says she is "very healthy," but days after chloramine was introduced, she got welts and scabs across her body. Once off the water, she said, her symptoms cleared up. Raubitschek is currently moving to a district that does not use chloraminated water.

In response to these allegations, the SFDPH spent six months from late 2004 to early 2005 studying the chemical. Although the SFDPH reviewed the available medical literature, the existence of complaints in other utility districts, and the chemistry of chloramine, it did not undertake a correlative study between the symptoms and the chemical. Such a study, it estimates, would require a sample of more than 142,000 people.

However, June Weintraub, a senior epidemiologist at the SFDPH, says the public health community would back a study if there were reason to believe the chemical might cause problems in some people. Part of the decision not to pursue further studies was based on an informal investigation into the dermatitis symptoms. Individuals were invited to call in to report symptoms and answer questions.

But Johnson-Kula says few knew about the investigation. Even as president of the CCAC, she did not know about it until there was a month left. She said that when people finally called in, "they were told the survey was over."

Seventeen people took the survey in the end. The results were published in a peer-reviewed journal and concluded that the symptoms were too heterogeneous to warrant further study. But Weintraub noted, "It is possible that people might experience different symptoms from the same irritant."

One SFPUC report adds that there was no change in the number of water-illness complaints between 2002 and 2006. The only change experienced was a decrease in dirty-water complaints.

"Given the evidence that we have available now, it absolutely points that there is not a public health concern," said Weintraub, who notes that 12 percent of people have dermatitis, which could explain the symptoms.

But how does that square with the city’s precautionary principle, which demands it err on the side of caution about the use of chemicals, even if that is not immediately cost-effective?

"There is less research on chloramine than on chlorine, [so] I don’t blame the SFPUC for moving over to chloramine," said Jennifer Clary, a water policy analyst at Clean Water Action. "[It’s] avoiding the devil you know for the one you don’t."

The precautionary principle may guide us to use chloramine, but it also demands we invest the resources to understand its potential effects. The recently defeated bill would have directed the UC Center for Water Resources to do a $140,000 study of the disinfectants used by the SFPUC and their by-products.

The director of the UC Center for Water Resources, Andrew Chang, told us, "If this study is not done, there is not much lost from a scientific point of view…. As far as we’re concerned, chloramine at the kind of level [one to two parts per million] is safe."

Marc Edwards disagrees. A professor at Virginia Tech, Edwards discovered that the switch to chloramine in Washington, DC, caused lead to be leached into drinking water.

"As a general rule … you ignore homeowner complaints at your own peril," he says. "More often than not, there is something to those complaints."

Edwards points to a recent case in Maui. Citizens were reporting rashes and breathing difficulties after chloramine was added to the water. He says authorities considered their stories "half-baked," but eventually the symptoms were linked to Pseudomonas aeruginosa, a bacterium whose presence was triggered by the addition of phosphates to the chloraminated water.

"Someone could and should be looking into this in a systematic and scientific way," Edwards said.*