September11,2012AdvisoryPanelMeetingSummary
Panel members attending: Bruce Alexander, Alan Bender, David DeGroote, Tom Hawkinson, Pat McGovern, Geary Olsen, Cathy Villas‐Horns, Lisa Yost Attendees: Jim Kelly, Joanne Bartkus, Aggie Leitheiser, Jeanne Ayers, Shannon Lotthammer, Betsy Edhlund, Paul Moyer, Blair Sevcik, Christina Rosebush, Jeannette Sample, Carin Huset, Al Williams, Jean Johnson, Jessica Nelson, Barbara Scott Murdock Welcome and Introductions Bruce Alexander welcomed panel members and attendees, and invited them to introduce themselves. He also called attention to a designated time slot for audience members to ask questions or comment on the topics, presentations, or discussions. Introduction and Background The September 2012 meeting was designed to review plans for the biennial Report to the Legislature, due in January 2013. Thus, the first part of the meeting highlighted the program’s achievements since its beginning. A more detailed review emphasized the work that responded to the legislature’s 2011 directive that the biomonitoring program focus on PFCs (perfluorochemicals) in the East Metro communities of Lake Elmo and Oakdale/Cottage Grove and on mercury in the Lake Superior Basin. Discussions of the studies and ideas presented during the review of EHTB achievements and the proposals for future projects on PFCs, mercury, as well as examples of other likely state concerns listed in the outline for the Report to the Legislature were postponed to the discussion of the Report. Achievements of the EHTB Tracking and Biomonitoring Program Jean Johnson reviewed the program’s history and accomplishments. Over the five years since the Minnesota legislature established the Environmental Health Tracking and Biomonitoring program in 2007, MDH has made significant progress in building and maintaining a strong new state program for tracking environmental hazards, population exposures (biomonitoring), and related chronic diseases and health outcomes. Jean highlighted a short list of the EHTB program accomplishments and benefits to Minnesota. During the five years of the program’s development, MDH accomplished the following: 
Investigated public concern about PFC exposure from drinking water in the East Metro; the first biomonitoring study documented higher than background exposures in long‐term residents. A follow‐up study showed that public health actions were effective at reducing exposure in the community. 1
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Identified a potential public health problem―10% prevalence of unhealthy mercury exposures among Minnesota newborns in the Lake Superior Basin. Data will inform efforts to strengthen actions aimed at mercury exposure prevention. 
Investigated children’s exposure to arsenic in Minneapolis; used chemical speciation to identify diet as a primary source of organic arsenic exposure, and found no association with soil contamination. The study reassured parents in the community and suggested ways to reduce arsenic exposure. 
Documented income and racial disparities in BPA and paraben exposures among pregnant women at Minneapolis‐Riverside clinic. Most BPA and paraben exposures were below US average levels. 
Cotinine measurements indicated that 14% of pregnant women tested were active smokers, comparable to the 13.8% self‐reported smokers in the MN Pregnancy Risk Assessment Monitoring Survey. 
Advanced MDH Public Health Laboratory capacity to measure PFCs, arsenic, BPA and parabens in human specimens and to develop novel methods to test newborn exposures to mercury, including heel stick spots and umbilical cord blood. 
Built state environmental epidemiology capacity for the collection, integration, and analysis of drinking water, air quality, and chronic disease data in Minnesota to examine trends and relationships. 
Successfully leveraged Minnesota’s investment in the EHTB program by attracting federal funding to enable the state to join the CDC Environmental Public Health Tracking Network of 23 states. CDC currently funds the Minnesota Public Health Data Access portal for broad dissemination of tracking data and interactive maps. 
Successfully added collaborative biomonitoring pilot projects to federally funded MDH and University of Minnesota projects, thereby further leveraging Minnesota’s support for the EHTB program. Ongoing Mercury Biomonitoring in Minnesota & Proposed Specific Aims Jean next reviewed the findings of the Mercury in Newborns in the Lake Superior Basin1 and the Advisory Panel’s motions to 1) recommend a cord blood: newborn blood spot study in collaboration with the University of Minnesota’s TIDES study, and 2) to plan ways to investigate mercury exposure in other populations in the state. Jean presented five goals, briefly described below, and explained the rationale and public health significance for these goals: 1
McCann, Patricia. 2011. Mercury Levels in Blood from Newborns in the Lake Superior Basin. GLNPO ID 2007‐942. Final Report. US EPA. 2
Goal 1: Measure the distribution of concentrations and geographic and temporal patterns of total mercury in a representative sample of Minnesota newborns to provide a baseline for ongoing surveillance of exposure in at‐risk sub‐populations in the state. Goal 2: Learn whether the problem of elevated mercury in newborns seen around Lake Superior is widespread in other regions of Minnesota and, if so, which subgroups are most likely to be affected. Goal 3: Measure how much maternal factors (e.g., age, income, education, race/ethnicity) and source contributions (e.g., fish consumption, dental amalgams, mercury‐containing products) explain variations in total and speciated mercury concentrations in newborns. Goal 4: Refine MDH laboratory methods for measuring mercury exposure in newborns. Goal 5: Inform and strengthen support for public health programs, actions, and interventions in order to use resources wisely, and to reduce the prevalence of elevated exposure in Minnesota newborns (exceeding the reference limit). Rationale: A pilot study2 that measured mercury in newborn blood spots suggests that a significant proportion (up to 10%) of babies in the Lake Superior Basin, and perhaps in other regions of Minnesota, may be exposed during gestation to mercury levels that could harm cognitive development. Significance: Nationwide, the incidence of learning and developmental disabilities (LDDs) appears to be rising.3 In 1999‐2000, the special education costs of LDDs amounted to $77.3 billion/year, about $12,500/pupil, nearly twice the per student cost for regular students.4 Improved monitoring of newborn exposure to mercury will yield data to guide public health actions, such as statewide fish consumption advisories for pregnant women and women of child‐bearing age and efforts to keep mercury out of the environment. Ongoing biomonitoring of newborns will complement current and proposed work in the Lake Superior region to screen women of child‐bearing age and improve educational interventions. The objective is to ensure that policy makers will be better informed so they can craft stronger public health policies and prevention efforts to protect Minnesota babies from developmental effects of mercury exposure during gestation. The ultimate goal is to move Minnesota communities toward a healthy start for all. 2
McCann, Patricia. 2011. Mercury Levels in Blood from Newborns in the Lake Superior Basin. GLNPO ID 2007‐942. Final Report. US EPA. 3
Scientific Consensus Statement on Environmental Agents Associated with Neurodevelopmental Disorders. Collaborative on Health and the Environment’s Learning and Developmental Disabilities Initiative, Nov 7, 2007. URL: http://neep.org/uploads/NEEPResources/id27/lddistatement.pdf 4
Center for Special Education Finance. American Institutes for Research. Special Education Expenditure Project. No. 1: What Are We Spending on Special Education Services in the United States, 1999‐2000? (246 KB) — Updated June 2004. URL: http://csef.air.org/publications/seep/national/AdvRpt1.PDF 3
Ongoing PFC Monitoring Recommendations Jessica Nelson reviewed the status of the PFC projects. Currently, biomonitoring pilot projects in the East Metro are close to completion. The follow up project’s questionnaire analysis is underway and will be finished by June 2013. She then presented the pros and cons of six scenarios for further PFC biomonitoring in Minnesota. Study options presented to the panel were the following:  An East Metro follow‐up in the same participants who took part in the past two projects  A MN reference population: a comparison population in another part of Washington Co. or elsewhere in state  Children or pregnant women in the East Metro and/or another part of MN  An occupational group likely exposed to PFCs: firefighters, ski waxers, plating shop workers, airplane mechanics  Anglers: people who fish in contaminated pools of the Mississippi River  No further study The 2012‐2013 Report to the Legislature Bruce Alexander led the discussion of the Report to the Legislature, commended the decision to begin with report with the program’s accomplishments, and reviewed the questions to the panel. These questions asked panel members 
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To identify the program’s most important accomplishments To make recommendations about  Whether the program should move ahead with plans for an ongoing program for Minnesota  Plans for ongoing mercury biomonitoring of newborns as described in the Specific Aims, and/or plans for another round of biomonitoring for PFCs in the East Metro or in a different population  Specific target populations of newborns or pregnant women for study  Specific analytes of concern in Minnesota in addition to mercury and PFCs.  Other urgent areas of concern for Minnesota that EHTB could address After commenting that the EHTB accomplishments are impressive, Pat McGovern suggested that, overall, the report should emphasize the program’s effects on Minnesotans by using case studies, individual stories, and comments from people who appreciated what the program did. She proposed emphasizing dietary sources of environmental toxicants and said that the arsenic study’s education and outreach illustrates why this study was important. She suggested that the report should give specifics in practical terms for lay people, such as including advice about diet in the report and samples of the handouts sent to study participants in the appendices. Alan Bender agreed, saying that people relate more to people and experiences than to data. 4
Bruce seconded this advice, saying that federal agencies now ask University researchers to describe the impacts of their projects in their grant reports. He cited MDH’s PFC study as a good example. It responded to a very clear concern in the community and a public health response [filtering to remove PFCs in well water and city water treatment] that is working. Some questions remain, but without the biomonitoring program, citizens would not have this answer that levels are declining. The mercury problem is another significant example. Many people have been asking questions about mercury. And in this case, biomonitoring documented a significant potential health problem in the Lake Superior Basin that might not have been picked up through national data. David DeGroote asked about the response rate in the second round of PFC sampling in the East Metro and suggested that the report explain why not everyone in the first study volunteered for a second round of biomonitoring. Jessica said that 10 participants who agreed to take part in the first round of PFC biomonitoring had checked the “do not contact me again” box in the consent form, before giving their blood. Thus, the pool of potential participants in the second PFC sample was smaller than the original study cohort. Bruce noted that the 88% participation in the second round was unusually good. Typically, participation in health studies these days is much lower— commonly, you get a 30% response to blood studies. The high participation in the second round shows that the community is very interested. David suggested that staff should show community engagement in the East Metro studies. Jessica Nelson said that program staff met with community members several times and did an evaluation for their opinions of the study and the public health response. We asked about the meetings, attendance, and other interactions. Alan pointed out that MDH was unable to say whether PFCs have any health consequences. The lack of information on health effects, said Jessica, is the primary frustration for participants, who would like to know whether these chemicals are, or are not, health risks. Despite that, the evaluations contained very positive comments, indicating that people are pleased about biomonitoring and about knowing their results, although they were concerned that they can’t know what their results mean for health. Lisa Yost said that the report’s readers are likely to be impatient readers, so a column with bulleted quotes from participants would offer a quick summary of community opinion. If the participants’ PFC levels are getting closer to the levels found in the CDC’s National Health and Nutrition Evaluation Survey (NHANES), she added, they are getting close to national population background levels. Lisa also recommended that MDH might try to communicate in ways that enhance health literacy or science literacy. Geary Olsen said that, when staff say they can’t interpret the data in terms of health effects, they may confuse the public or the legislature, since another branch of MDH has done risk assessments that led to published Health Risk Limits, or HRLs, for PFC levels in water. Lisa asked whether there is a biomonitoring number for safe PFC levels in blood, and Geary said that there is. The HRLs, based on reference doses developed in primate 5
studies, indicate that people can safely drink water with that PFC content for a lifetime and consequently indicate some estimated safe PFC blood levels. He turned to Jim Kelly, from MDH Environmental Health, for confirmation, and Jim replied that his division could probably add some information [to support interpretation of the biomonitoring results]. Geary said the number is based on thyroid and cholesterol effects. Aggie added that sometimes the public tells us “we want zero.” Lisa agreed that comparisons with a reference dose (RfD) are helpful, as was done for interpreting mercury exposures. Geary had commented earlier that studies of American Red Cross blood donors in Minnesota and study donors from the general population also had established some background data on Minnesota PFC levels. Results were consistent with NHANES (national) data, but Geary also noted that the Red Cross data did not come from a random representative sample of the Minnesota population. Bruce said that the progress report on biomonitoring capacity involves convincing the legislature that environmental issues unique to MN can’t be addressed by any other entity than MDH, and that this state capacity enables MDH to respond to local and in‐
state needs. He advised making that into an impact statement that CDC’s NHANES can’t effectively study these small populations. He also commented that the building of state capacity has been buried, yet this capacity allows the state to turn to MDH when it needs to respond to citizens’ concerns. Legislators have to recognize that some environmental issues can’t be farmed out to national agencies. Bruce suggested highlighting both accomplishments and challenges. The challenges are an aspect that hasn’t been brought out. Highlighting the Riverside study, for instance, illustrates that the state has some populations that are difficult to connect with, and some of their exposures are very different from those in the dominant population. We have challenges in engaging these populations in this activity. Alan agreed and said it will take resources to get at these populations, and noted that some members of the legislature may have interests in specific populations. Jeanne Ayers suggested addressing challenges and next steps for issues we couldn’t address before. Alan commented that these projects are like plumbing work – it’s a matter of paying now or paying more later. We should feel really good about this project. He also suggested that the proposal needs to say how the program intends to address those challenges. Bruce said that follow up for what we have done is fine. Bruce then directed the panel’s attention to the program’s next steps: protecting future generations and considering the specific proposals for more work on mercury and PFCs, among other suggested problems. With respect to PFCs, David said, the job is half done. One more round of PFC analysis is appropriate. If the community is still concerned, said Pat McGovern, a new round of analysis would help to satisfy them. Aggie noted that the East Metro is a very active community that knows that, even though their test results show declines in PFCs, their levels still are above background. Geary agreed that it would be very important to measure their PFC levels again. But he also cautioned that it will be a long time before those levels reach background, and it’s important to make 6
citizens understand that PFOS, PFOA, and PFHxS have long half‐lives of 4 years or more. PFBA, on the other hand, has a half‐life of 3 days. Alan added that for the longer half‐
life chemicals, the baseline is also falling, so the decrease will be smaller. Geary said, that may make it difficult to catch up with the US baseline levels, but this study has been a good success story for biomonitoring, and the participants haven’t even reached a half‐life period yet. Bruce said it would also be useful to expand the sample size in the community and to include new residents. If new residents have background levels, that will reassure the others. His guess is, based on the decline in PFC levels in the long‐term residents, that new residents from non‐exposed communities will have only background levels because the PFCs in drinking water in the East Metro have been removed. Lisa agreed, but said she was not [otherwise] on board with all of the proposed PFC projects. Geary said the project could be two separate studies, and the first—repeating the study in the same group of participants— is relatively straightforward since you are updating the original study. Jeanne Ayers asked whether the East Metro had any racial or ethnic differences, and whether new residents could be changing the demographics. Jessica replied it was a pretty homogeneous white community. Bruce moved the discussion on to mercury, saying that mercury exposure is an important issue in Minnesota, an issue that only Minnesota and MDH can answer. He supports continuing work in this area, and said that the team has done a good job on posing the questions of potential variability between cord blood and newborn blood spots, the prognosis for the rest of Minnesota, and the potential for exposures in disparate groups in the state. Alan asked, how would the panel choose between these two projects if only one is funded by the legislature? They represent two different kinds of issues, one with a known biological outcome and the other with a known concern in an active community. And am I correct that PFCs and mercury may affect very different ethnic groups? If so, comparing these two projects is almost an environmental justice issue. Aggie added that the panel’s advice on that would be useful, given that the issues for biomonitoring in MDH have often taken a political bend or have been legislatively directed. Your thoughts about priorities would be helpful. Geary asked, does the panel have a statement of public health concern for one chemical over another? Implicit in that argument that you are putting one chemical over the other is that you are using a definition of risk. Alan said that, from what we know, is that PFCs don’t have a public health outcome. Then Alan asked Geary directly, if he had to choose one or the other, which one would you choose? Geary responded to Alan’s question by saying, if we compare these things side by side, he would be more worried about mercury, but that is his immediate opinion in response to Alan’s question. In no way was he offering a risk assessment in responding to the question. 7
Bruce said, we can reframe the question: If MDH receives only enough money to study one of these two problems, do MDH and its Advisory Panel members get to choose which is more important to follow up? We should consider what public health action we could take for each. It’s important to follow up the PFCs and monitor the controls that are in place for PFCs. We have some control on PFCs now. But for mercury, it’s an open book. We don’t know what the extent of the problem is, as we do for PFCs. Geary added that risk management has happened for PFCs, and is needed for mercury. Therefore, we should recommend a mercury study (vs. PFCs) if you had to choose only one—referring back to Alan’s question—because mercury has greater potential for public health action. Bruce commented that he had been disappointed in the legislative directions in the original legislation, and said that MDH experts should have some flexibility to make decisions about priorities. Lisa agreed, saying that she liked weighing the value of doing one study rather than the other. Jeanne Ayers added, rather than saying which issue is more important, it’s important to say which has value for the next step—risk management. Lisa said, I need to answer that risk question to evaluate these two situations in terms of risk management. Bruce asked for a motion to recommend that MDH pursue the outlined activities on PFCs and mercury. David moved that the panel recommend that these two projects move forward. Pat McGovern seconded the motion, and all said, “Aye.” Bruce added that the panel had a write‐in vote from Fred Anderson in favor of follow up on the PFCs. Lisa agreed with the vote, but specified that she is not on board for all [PFC] proposals. Jessica asked for more clarification about which PFC studies should be done. Geary said his understanding is that MDH should pursue the East Metro work in another continuing round of PFC monitoring and then have a second study in a larger sample, which, Bruce added, definitely should include other residents in the East Metro to follow up on the public health intervention. Panel members agreed. Lisa asked whether that study could include anglers who fish in the Mississippi’s Pool 2. Jean Johnson said the project could capture these. But Geary thought the project wouldn’t find many anglers, since recent changes in the fish advisories recommend eating only one fish meal per week because of many other chemical pollutants that have the same dietary level in fish advisories. Jim Kelly affirmed this statement. Bruce then observed that we’ve demonstrated the value of the program with the studies of PFCs, arsenic, mercury, and others, but I think it would be useful to state in the report that we’ve demonstrated the importance of this program, mention examples of potential issues, and then ask for continued State support for biomonitoring to address emerging and re‐emerging problems in MN, as determined through scientific assessment. Geary added that we not only need to address emerging issues, but also need support for building laboratory capacities. Aggie suggested that staff not frame the argument in vague terms of “capacity building,” but in terms of the [benefits to Minnesota citizens]. Lisa asked about the status of lead (Pb) testing in Minnesota, given that this public health issue is so well understood and well established [Note: CDC has discontinued funding for lead surveillance. See Advisory Panel Meeting book from 8
March 13, 2012]. Jim Kelly from the Environmental Health Division said that children will still be tested for lead poisoning at their doctor’s recommendation, but MDH is losing funding for surveillance, which limits its ability to follow up on elevated blood lead cases. He pointed out that city health departments have funds for clean‐up, but don’t cover MDH’s role in following up on children with elevated blood lead levels. Alan added that this is another example of loss of core capacity at MDH. (~1:57 hour) In looking at the short list of examples of concerns, David asked, isn't exposure to arsenic, cadmium, and other heavy metals also a problem in Minnesota? Heavy metals are known to cause health problems, yet the program’s example list contains only lead and mercury. Is there an additional cost to broadening the work on heavy metals? Tom Hawkinson said that the TIDES project was looking at lead, mercury, and cadmium, which can all be analyzed as a single suite of metals, adding that this is another argument for the mercury follow up with the TIDES study. MDH chemist Betsy Edhlund said that costs depend on which metals are being analyzed. Analyzing a suite of metals doesn’t involve much added cost. Bruce said that other exposures can occur in different Minnesota populations, such as manganese in some areas and arsenic in others, so the program needs the capacity to address emerging concerns. Geary said he was concerned with what was not on the list of examples: pesticides and pesticide drift. Bruce agreed that this is an important issue, but suggested that the most appropriate way to address these would be to have MDH and the Minnesota Department of Agriculture (MDA) meet to figure out key questions about pesticide use and concerns. Jean Johnson said that pesticides—and especially pesticide drift—are definitely an issue, but is unsure whether biomonitoring would be the best tool to use in studying pesticides. Cathy Villas‐Horns said that both agencies hear about concerns, and that MDA would share information it has from misuse of pesticides, complaints about pesticides and other information when discussing this issue with MDH. The issue of pesticide drift comes back repeatedly. Jeanne Ayers asked whether Bruce was suggesting that agencies should pool their concerns about pesticides, and pesticide drift and whether biomonitoring would fit in. If so, she said, the panel should have a motion for a vote to include the recommendation in the report to the legislature. Otherwise, she thought the meeting should just be in the work plan. Bruce asked, where would biomonitoring fit in? And Jeanne said that she concluded that pesticides should be part of the work plan, but she was not hearing that they should be written into the report recommendations. Geary said the report should acknowledge pesticides somewhere in the report, as they are a concern, and Pat suggested that the report refer both to emerging concerns, such as manganese, and persistent concerns, such as pesticides. Bruce asked whether anyone had comments on the Report’s tracking progress report. Jean said that because tracking had been funded by CDC, rather than the State, for the last two years, she wasn’t sure it should go into the legislative report. Aggie said that the report should include tracking activities for the past two years, including the fact that it is currently funded by CDC. MDH doesn’t want it to be invisible, she said. The 9
hazard‐to‐exposure‐to‐health outcome paradigm involves both tracking and biomonitoring. In addition, because tracking was an important part of the founding legislation, its current progress should be reported. Jeanne Ayers added that the CDC funding for tracking continues through August 2014, but because the funding for the program has been shifted into the Affordable Care Act, it’s at greater risk than if it were still in CDC’s operating budget. Geary Olsen asked, has the panel had ever written a recommendation or endorsement to submit with the biennial report to the legislature? Aggie said that other programs’ reports to the legislature have been accompanied by endorsements in the past. Bruce and the other panel members agreed that the panel would provide an endorsement in December. PFC Presentation: Update on C8 Probable Link Reports Jessica Nelson discussed the upcoming C8 “probable link” reports, which are emerging from the study of health status and exposure in Ohio Valley communities exposed to PFOA (C8), a PFC released by a manufacturing plant in Parkersburg, West Virginia. The study, the result of a lawsuit, requires the researchers to issue “probable link” reports, defined “to mean that, given the available scientific evidence, it is more likely than not that… a connection exists between PFOA exposure and a particular human disease.” Jessica noted that the scientists leading the C8 Study are careful not to say the word “causal,” and that this makes communication with the public more complicated. Although the populations in West Virginia and Ohio had exposures about 10 times higher than those in the East Metro, the media and the East Metro residents are very interested in the C8 Health Project reports. MDH receives media calls each time “probable link” reports are released. Thus, anticipating a flurry of calls when more of these reports are released in October, MDH has developed a list of talking points, which Jessica presented to the panel to elicit their advice and suggestions for alterations or clarification. The talking points stress the following: • MDH is playing close attention to the reports. MDH shares the community’s concern about possible health effects of PFCs and is working on understanding these findings better. • “Probable link” does not necessarily mean that PFOA causes these diseases. • Exposure levels in the East Metro were 10 times lower than those in Ohio and West Virginia. • Many of the studies haven’t been published – and it will take time for the findings to be published and for other scientists to review the information and vet the results. • MDH is not changing its medical care recommendations—people should get regular health check‐ups and screenings as recommended by their doctors. 10
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The good news is that blood PFC levels are decreasing in East Metro. Pat liked the fact that the approach points out that East Metro residents were 10 times less exposed than the people in the mid‐Ohio Valley, and she suggested that MDH might do more follow‐up communication with healthcare providers. Lisa noted that the C8 studies came out of a legal requirement. Contrasting this with the way researchers typically do science, she hypothesized that such legal actions may create high stakes for finding positive (disease) outcomes. Bruce cautioned against that view, saying that if industry funds such a study, the implication people draw is that the industry wants a negative (no disease) result. We need to focus on the scientific merits of the studies, and Lisa agreed. Jessica noted that exposed residents will not get direct financial benefits from the settlement, but that any positive findings will trigger medical monitoring for possible disease. Panel members agreed with Bruce’s recommendation to focus on the scientific merit of the study, rather than on the source of the funding. Alan also stressed that it takes time to build scientific consensus: a single published paper is not a consensus. Biomonitoring Updates and Tracking Updates Panel members had no questions or comments on the updates. Legislative Report Aggie Leitheiser reported that the governor and MDH are working on parts of the Governor’s budget and are in conversation with the MPCA about the EHTB program. Funding for MDH’s EHTB program comes from the State’s Environmental Fund and is funneled through the MPCA. The challenge for the governor and for state agencies is that the state faces a $1.7 billion budget deficit, and that does not include repaying shifts in school funding, which total some $3‐4 billion. Jeanne Ayers added that state agencies are trying to explore hopeful avenues for reducing the budget deficit, but only 10 to 15% of MDH’s budget comes from the state’s general fund. She has not known any time before when both state and federal budgets were being cut at the same time. Some 90 percent of MDH funding comes from federal grants, and federal government funding is undergoing severe cuts that will result in far fewer grants. Alan noted that MDH has turned to using federal grants to support its core programs. As a result, MDH has no easy way to cut expenses and now will have to set priorities for its core programs and eliminate some of them. But, he warned, we’ll pay in the future if we don’t [have programs that focus on] prevention [of exposure and health problems] now. New Business Bruce asked the panel for suggestions about new business or new topics for discussion. Geary suggested that Jessica bring the panel up to date on the remaining C8 probable link studies and accompanying MDH communication about them. David asked for a report on the Minnesota Department of Agriculture (MDA)–MDH conversation about pesticides. 11
Bruce then asked for a motion to adjourn. Pat McGovern moved to adjourn, and the motion was seconded and passed. Summary of Meeting Decisions In summary, the panel…  Discussed and made recommendations on the proposed Report to the Legislature;  Concurred with the plan to highlight EHTB accomplishments;  Recommended that EHTB use case studies, individual stories, comments from participants, survey comments, and bullet points to make the report easy to read and understand;  Voted to recommend that EHTB follow up on the 2 analytes specified in the last legislative directive (PFCs and mercury) to… o Repeat the biomonitoring study of PFCs in the same participants in the East Metro to confirm that PFC levels are declining and expand the population to include new East Metro residents, who are likely to have only background PFC levels. o Follow up on the mercury findings by biomonitoring newborns in other regions of Minnesota to identify disparities, and geographic and spatial patterns in mercury exposure.  Recommended that EHTB include the need to address emerging concerns and/or persistent concerns, such as pesticide drift in the Legislative report, and requested that staff report at the next panel meeting on the Minnesota Department of Agriculture (MDA)–MDH conversation about pesticides.  Decided to submit a letter of endorsement for the program to accompany its Report to the Legislature at the December 2012 meeting. 12