Richard Weisler flips through the map he made of his hometown. About three feet wide, the map shows the streets of Salisbury, North Carolina. Handwritten addresses and names mark certain houses. Weisler lifts up one of the transparent sheets clipped to the top and points to a Little League baseball park, right next door to a now-abandoned petroleum tank farm where environmental remediation workers vented gasoline into the air. “The ball field just recently closed,” Weisler says. “Do you think, if they had known about the contamination, the town would have built it there in the first place?

“This map is getting old,” he says. “Some of these dots are falling off.” He bends to pick one up. “This dot,” he says, “this was somebody’s life.”

The adhesive dots mark the homes of each person who got sick. A pink dot means a pneumonia death. Red is brain cancer. Black, suicide. Those dots cluster around the Milford Hills and Meadowbrook neighborhoods, which sit immediately downwind from the old petroleum tank farm, a liquid-asphalt terminal, and an asphalt plant that once included a N.C. Department of Transportation (DOT) site for testing asphalt quality.

To an untrained eye, the dots on Weisler’s map seem to form a pattern. It makes common sense. And that is Weisler’s point. It seems that, in these neighborhoods, there were too many rare brain cancers, too many suicides to be a coincidence. Weisler doesn’t know what caused those people to get sick. But he wants those who study such things to find out whether the culprits were chemicals now known to have been lingering in those neighborhoods, both beneath the ground and in the air.

Weisler is thin, with a shock of curly, salt-and-pepper hair. Talk to him and you wonder where he gets his energy. He pulls out document after document—letters he has written, reports he’s tracked down. He reels off the names and ages of children in these Salisbury neighborhoods diagnosed with rare brain cancers. He can talk about these cases for hours.

Where did the chemicals come from?

At the asphalt plant, the DOT testing required solvents, chemicals such as trichloroethylene and tetrachloroethylene. The DOT disposed of the chemicals by dumping them on the ground until 1980, when the practice was federally banned. The Salisbury Post broke the story of the DOT site in 2000, after Weisler looked at the DOT’s own studies showing contamination at the site and notified county and state health officials. Weisler has also brought attention to what happened at the tank farm near the ball field, using public reports from the N.C. Department of Environment, Health, and Natural Resources (N.C. DEHNR). The tank-farm company discovered in 1991 that gasoline as well as toluene and other chemicals were contaminating the ground. The contamination was cleaned up using a method called “soil vapor extraction and bioventing.” That means, basically, pumping the gasoline from the ground into the air and letting it vaporize. Weisler’s concern is that the method helped clean up the ground but soiled the air. “According to a 2001 air-modeling report from N.C. DEHNR, benzene was a mere 123,333 percent above the accepted ambient level at the site of the former petroleum tank farm,” Weisler says. Benzene is a known carcinogen. The permissible exposure limit for benzene in the air, set by the Occupational Safety and Health Administration to protect workers, is only ten parts per million for an average of eight hours.

Weisler, an adjunct professor of psychiatry at Carolina, never expected to be reading soil and air reports and counting cancer cases. He’s not an epidemiologist by profession, though he studied the field briefly during a summer public health fellowship at the UNC School of Public Health when he was in medical school at Carolina. What made him start putting dots on that map? Back in 2000, his mother, Rita Weisler, was dying of lung cancer. As he was going through her papers he found a report about the air quality in her Salisbury neighborhood. A state agency had done the assessment in response to his mother’s and other neighbors’ complaints about the odors from the nearby asphalt facilities. The report said that the air was as safe as typical urban air. But it also noted that at two places at the asphalt plant, levels of chemicals such as benzene and toluene were so high they were “off the chart,” Weisler says.

That got Weisler thinking, especially when he and his mother talked about all of her neighbors who had gotten cancer. “I took this walk with my mother, and she lived right here,” he says, pointing to his map. “So we turned a corner, and she said, you know, ‘I can’t understand why everybody in my neighborhood is getting sick. This person over here just got brain cancer, and this man was thirty-six when he developed brain cancer. This person is dying of lung cancer, and so did that neighbor.’ This particular house up here,” he says, “it turned out that a husband died of acute myelogenous leukemia. The wife died of leukemia. And the sister of the wife, who frequently lived with them, also died of leukemia.”

After finding out about the chemicals in his mother’s neighborhood, Weisler started tracking cancer deaths in the area. He wasn’t any stranger to digging up data; in his day job, he conducts clinical trials of drugs and other procedures used to treat or diagnose mood disorders and other psychiatric illnesses. He started writing letters, making phone calls, and reviewing death certificates.

Chemicals linked to suicide?

Weisler’s effort to draw attention to Salisbury included a preliminary study that he and colleagues presented to the U.S. Psychiatric and Mental Health Congress in November 2004. The team started counting the cancer deaths in a certain time period, using death certificates. Then they began looking at suicide rates as well. One of the chemicals known to emit from asphalt plants, hydrogen sulfide, is suspected to affect mood and responses to stress. In animal studies, it has been shown to alter levels of brain chemicals involved in mood regulation such as serotonin, norepinephrine, dopamine, aspartate, and glutamate.

Hydrogen sulfide is what often gives asphalt-plant emissions their characteristic rotten-egg odor. And people in the nearby neighborhoods had often complained about that very odor. “That’s also one of the reasons we stuck with our study of Salisbury—from 1999 to 2004, there were over five hundred formal complaints to the city about foul-smelling air and associated respiratory problems in these neighborhoods,” Weisler says.

The team counted suicides and cancer cases in two U.S. census tract block groups in Salisbury that are downwind from the asphalt plant. A total of 1,561 people called these neighborhoods home. Between 1994 and 2003, death certificate evaluations showed a three-fold statistically significant increase in the suicide rate. Four deaths by suicide in adults were reported among the 687 residents in the census tract block group one. Two adult deaths by suicide were reported among the 874 residents of census tract block group two. That adds up to six suicides, when only two deaths by suicide would be expected for this population over a ten-year period.

“For example, here in the block-group-one neighborhood, in the mid-nineties, we found one death by suicide for about every two hundred thirty people during the worst twelve-month period, versus an average of one death by suicide for every 8,621 people in the rest of North Carolina,” Weisler says.

In counting cancer cases, the Weisler group’s preliminary study had indicated that from 1995 to 2000, the incidence rate of primary brain cancers in these neighborhoods showed an increase about 6.4 times greater than expected for the population.

Steve Wing, professor of epidemiology at Carolina, has met with Weisler and visited Salisbury with him. Wing is known for his 1997 study that reanalyzed data about the 1979 nuclear accident at the power plant on Pennsylvania’s Three Mile Island, suggesting that radiation increased cancer incidence among people living downwind of the plant. Wing says that though it’s hard to tell from preliminary data what the people in Salisbury were exposed to and when, he admires Weisler’s social conscience. “I think Dr. Weisler’s strongest suit is that he’s taking a precautionary approach,” Wing says. “I wish we had more people who had the interest and the feelings of obligation to come forth with such information. He’s taken a stand to raise some important questions. Sometimes we have to shed light in places where people want to keep it dark.”

Playing the waiting game

In 2000, Weisler, along with Rowan County Health Director Leonard Wood and North Carolina Health Director Dennis McBride, asked the U.S. Centers for Disease Control (CDC) to study the cancer incidence in Salisbury. In 2005, after years of making noise about the contamination, Weisler eagerly awaits the results of the CDC study. In October 2005, a CDC spokesperson says the report is under review and will be released in late December 2005. “I haven’t seen the report,” Weisler says. “But I know what our data show.” [Editor’s note: the CDC report has now been released.]

As Weisler waits, he further explores a possible connection between chemical exposures and suicide by tracking suicide rates in Haywood County, North Carolina, which is home to a paper mill in the town of Canton. “We thought it would be important to find out if we could see the suicide findings someplace else, to find out if Salisbury was just an accidental finding, or if it meant something in a more significant way,” he says. The chemicals released from the paper mill also include hydrogen sulfide. And, just as in Salisbury, Haywood County residents have complained about nausea and shortness of breath possibly caused by the fumes.

In November 2005, Weisler and colleagues presented a study to the U.S. Psychiatric and Mental Health Congress showing that Haywood County’s suicide rate nearly doubled in 1997. Between 1996 and 1997, the age-adjusted suicide rate jumped from 12 suicides per 100,000 residents to 20.9 per 100,000 residents. Since 1997, the rate has remained elevated, Weisler says, peaking in the year 2000 at 29.7 per 100,000 people. In all of North Carolina, the average age-adjusted suicide rate for the years 1997–2001 was about 11.4 per 100,000 residents per year.

Weisler’s group speculates that the increase in Haywood County might be associated with the mill’s change in 1996 to a bleach filtrate recycling process, which involves the burning of chlorinated compounds, possibly releasing higher levels of chemicals into the air. He’s calling for a full study characterizing what chemicals are released by the mill and in what amounts. Their air permit, Weisler says, lists almost three million pounds of toxic chemical releases.

Again, Weisler acknowledges that the issue needs further study. Are the paper-mill fumes just a nuisance, or a serious danger to health? The people in Canton, Weisler says, shouldn’t have to wait to find out. If he has anything to do with it, they won’t. He keeps making phone calls, writing letters, and tracking census and health-outcome data. “Our entire study group feels that there is no reason for anyone to panic based on these observations,” Weisler says. “But we argue that public health interventions to reduce suicide and child abuse and neglect, further health-data analysis, and environmental assessments are needed.”

And he hasn’t forgotten about those two neighborhoods in Salisbury. “With the help of the city and the county, there’ve been significant improvements in air quality,” Weisler says. Odor complaints have decreased since the asphalt company in 2000 installed a carbon filtering system on its storage tanks and loading platforms. “The previously untreated and uncontrolled petroleum remediation sites were shut down in 2001 and 2002,” Weisler says. “A full and safe cleanup of the nearby petroleum-contaminated sites, the solvent-contaminated asphalt company site, and the former NCDOT asphalt testing-lab site has yet to happen.”

In 2005, Weisler participated in a Piedmont Area Behavioral Mental Health Agency forum to inform people that early treatment for depression, other mood disorders, and substance-abuse disorders can help prevent suicide. “Even if the data aren’t firm yet,” Weisler says, “we can do education and toxic-exposure reduction while studying the problem.

“That’s what I’m hoping will happen in Haywood County, too—that they will implement those kinds of changes while studying what happened,” he says. “And get people help.”

Weisler is also an adjunct assistant professor of psychiatry at Duke. Coauthors of the Salisbury study are Jonathan Davidson, professor of psychiatry at Duke University; Lynn Crosby, a toxicologist with Blue Ridge Environmental Defense League (BREDL); Lou Zeller, BREDL director; Hope Taylor-Guevera, director of Clean Water for North Carolina; Sheila Singleton, executive director of the N.C. Depression and Bipolar Support Alliance; and Melissa Fiffer and Stacy Tsougas, undergraduates at Duke University’s Nicholas School of the Environment and BREDL summer interns. The Haywood County study also includes Duke undergraduate Lisa Turner.