Last week FRONTLINE touted a 2019 FACHEP research study that sought to examine the role of Point-of-Use (POU) filters in causing “bacterial infections,” such as pneumonia, and to cast doubt on EPA’s position about the current safety status of Flint water. The “results” of the new research study are that 70% of the Flint residents with POU filters sampled had pneumonia (7 out of 10 residents), 100% had bacterial infections (10 out of 10 residents), and 50% died (5 out of 10 residents).
The FACHEP researchers also did a “control” study on POU filters in Detroit—1 filter was sampled and no pathogens were detected. The one Detroit resident in the study using a POU filter, apparently did not obtain an infection or die.
On the basis of the reported 100% (10/10) infection rate in Flint and the 0% (0/1) infection rate measured in Detroit, FACHEP concluded:
These results have important implications for immune compromised patients, and other cities with aging infrastructure where PoU filters are being considered.
We found this research study to be so astonishing, that we are publishing the entire 250 word “peer-reviewed Journal” open access article below for Flintwaterstudy readers (red emphasis added).
Bacterial colonization of drinking water: implications for an aging U.S. water infrastructure
G. Maki1,, S. McElmurry2, P. Kilgore3, N. Love4, H. Misikir5, M. Perri5, M. Zervos6
1 Henry Ford Hospital, Infectious Disease, Royal Oak, MI/US
2 Wayne State University, Department of Civil and Environmental Engineering, Detroit/US
3 Wayne State University, Department of Pharmacy Practice, Detroit/US
4 University of Michigan, Department of Civil and Environmental Engineering, Ann Arbor/US
5 Henry Ford Health System, Division of Infectious Diseases, Detroit/US
6 Henry Ford Health System, Infectious Disease, Detroit/US
Open Access PlumX Metrics
DOI: https://doi.org/10.1016/j.ijid.2018.11.088
Purpose: In 2014 the city of Flint began using water from the Flint River rather than Lake Huron in a cost-saving effort. Improper treatment resulted in corrosive water causing elevated levels of lead throughout the municipal drinking water system with grave consequences to the children living in Flint resulting in one of the country’s worst anthropogenic disasters. Factors such as decreased chlorine levels were favorable to growth of various bacteria including legionella, with 91 cases of legionella pneumonia in 2014-2015 with 14 deaths reported. In response to issues with lead, PoU filters were recommended for all households in Flint. The filters were successful in reducing lead exposure; however, their effects on bacterial infections have not been studied.
Methods & Materials: 10 homes in Flint with suspected cases of infection had water collected from the sink with the filter on, off, and from the shower. 10 Detroit homes were used as controls; water was collected from the kitchen sink and shower as only 1 out of 10 homes had a filter. 100 mL sterile cups were used for water collection.
Results: Results of Flint samples are shown in Table 1. No pathogens were detected from Detroit water. Residents of 7/10 homes in Flint had severe pneumonia, 1 sepsis, and 1 folliculitis. 5/10 patients died.
Table 1
Flint Water Results.
| Home | Filter | No Filter | Shower |
|---|---|---|---|
| 1 | None | ND | None |
| 2 | P.aeruginosa 14 CFU/mL | None | None |
| 3 | A.baumannii 6 CFU/mL | None | None |
| 3 sample 2 | A. baumannii 35 CFU/mL | ND | A.baumannii >1250 CFU/mL |
| 4 | None | None | None |
| 5 | P.aeruginosa >277 CFU/mL E.cloacae 26 CFU/mL | ND | None |
| 6 | P.aeruginosa >312 CFU/mL E.cloacae >312 CFU/mL K.oxytoca >312 cfu/mL K.pneumoniae >312 CFU/mL S.maltophilia >312 CFU/mL A.baumannii >312 CFU/mL | None | None |
| 7 | P.aeruginosa >5000 CFU/mLA.baumannii >500 CFU/mL | ND | None |
| 8 | None | P.aeruginosa >5000 CFU/mL A.lwoffii | None |
| 9 | ND | None | None |
| 10 | ND | None | None |
Conclusion: The results of this study showed that even two years after switch of the water back to Huron Lake, Flint municipal water showed high levels of pathogens. These results have important implications for immune compromised patients, and other cities with aging infrastructure where PoU filters are being considered.
SERIOUS QUESTIONS RELATED TO THE IJID AND FRONTLINE ARTICLE
For those blog readers who are not regular readers of the scientific literature, it should be pointed out that this is an extraordinarily short journal article, that does not meet basic standards of disclosing enough information to ensure that the data are trustworthy, that the study could be reproduced by other researchers, or that the “results” are not misinterpreted. While easy enough to read, the above journal article and the related FRONTLINE story that promotes its conclusions, raised serious ethical questions for us.
We were especially curious about FRONTLINE’s involvement in the research, details of the study design, the process by which the ethics of this human health research study was approved, and how the findings relate to Dr. Love’s scientific prophesy (i.e., predetermined research conclusion) about Flint POU filters back in 2016.
FRONTLINE Involvement. In the original story, FRONTLINE bragged that it was THEIR REPORTERS who had collected the crucial microbiological samples used in the IJID article. It is highly unusual for reporters to be acting as scientists, and the journal article made no mention of this important fact. We, therefore, wrote FRONTLINE and asked about the scientific training that their reporters had received before collecting the samples and we also questioned the ethics of not disclosing FRONTLINE involvement in a human health research study published in IJID. FRONTLINE wrote back, stating that they did not collect the samples for the studies afterall. The online story was then changed to indicate that a different team including Dr. Zervos had collected the samples.
Study Design. We were intrigued by the statement in the FRONTLINE article and in the paper that for the IJID study:
“In 2018, a team including Zervos tested water filters from 10 Flint residents’ homes that they suspected were infected.”
On what basis did Zervos “suspect” the residents (or filters) were infected? Did the authors also “suspect” that the residents (or filters) from the control study of 1 Detroit home “were infected?” Could such clues help solve the mystery, of how 100% of Flint residents in the study were infected and 50% died, whereas there was a 0% infection rate in Detroit? We asked FRONTLINE if they had participated in the design of the study, selection of the sample sites, or if they knew what year the study subjects in Flint had been infected and died. We received no response.
Institutional Review Board (IRB) Approval. We [Dr. Susan Masten (MSU) and Drs. Edwards, Roy and Pruden (VT)] wrote the IRBs at Henry Ford Medical Center, Wayne State, and U of M to try and better understand the process for approval of a POU human health study with 10 residents in Flint and 1 resident in Detroit. We were curious how such a study could be approved in the first place, or how the cited data can support the internationally broadcast generalizable conclusion stating that this work has “important implications for immune compromised patients and other cities with aging infrastructure where POU filters are being considered.” We even started to wonder if FACHEP’s IJID study had ever received IRB approval in the first place. That is, all major research institutions have an IRB, in order to ensure that human subjects are adequately protected when they participate in research, with the fundamental principle that the research must be justifiable and that any potential benefits of the research must outweigh the potential risk to the people participating. We fully expected an immediate and transparent response from the respective IRBs at these institutions. To our dismay, we only heard back from one of the IRBs (U of M), indicating that we should consider submitting a FOIA request if we wanted additional information.
Timing. We find FACHEP’s hypothesis (or is it a FRONTLINE hypothesis?), that the Flint POU filters caused the Legionnaire’s disease outbreak and pneumonia deaths, to be illogical. Afterall, the Legionella outbreak was over in late 2015 and the POU filters were not widely distributed throughout Flint until after that time. How does sampling 10 Flint homes with POU filters in 2017-2018, explain the deaths and infections (that we helped uncover through our own research and FOIA’s) back in 2014-2015? Outside of these IJID study “results,” where is the evidence of a health outbreak of infections and deaths in 2017-2018 due to POU filters? We asked both FRONTLINE and Henry Ford IRB to defend the logic presented in the articles, but we have not received a response.
Dr. Love’s 2016 Prophecy Comes True. We do not believe it is a coincidence that Dr. Love foresaw the stunning IJID conclusion alleging dangers of POU filters for immunocompromised Flint residents, way back in September 26, 2016, before she had actually collected any defensible data on pathogens. Dr. Love is now using the IJID article results, with its claims of deaths and infections associated with POU filters, to support her on-going dispute with the scientific consensus of CDC, EPA and the State of Michigan researchers that Flint water is meeting existing safety standards. We point out that these agencies, unlike Dr. Love, actually have expertise in potable water.
In the FRONTLINE article, Dr. Love also repeated her debunked claim, that the POU filters are “the only barrier between safe and unsafe water” for Flint residents. For some strange reason beyond our comprehension, Love stubbornly continues to ignore the multiple barriers to harmful fecal bacteria that are in place, and the fact that the POU filters are provided as additional barrier to remove lead above and beyond all existing legal requirements for water safety.
In the immediate aftermath of duping the FRONTLINE reporters into promoting her dubious narrative and ongoing dispute with the EPA and State of Michigan, with the IJID article, on September 18, 2019 Dr. Love tweeted (red emphasis added):
Appreciated “fireside chat” set up by @cee_utk on topic: Env Engr and Sci Academic Scholarship in Service to Society: Our Role and Responsibility. My goal is to initiate a national dialog about this important topic via my @AAEESdotORG Kappe. Will share outcomes at end of tour. 10:55 PM · Sep 18, 2019·Twitter Web App
We fervently hope that Dr. Love’s numerous deeds in Flint, as illustrated by the new IJID and FRONTLINE article, will be successful in initiating a dialogue on this “important topic” (in the words of her own tweet). We can’t imagine a more exemplary ethics case study for AAEES (and AEESP) than her disastrous research and relentless fearmongering in Flint.
In fact, we urgently recommend that everyone in AAEES and AEESP, take a few moments of their time to read Love’s IJID and FRONTLINE article in its entirety (and the background in our prior blogs in this series), to discuss the ethics of conducting, publishing and promoting such a dubious study. We invite members of the scientific community to share their thoughts nationally with the AAEES/AEESP community, especially our students, via social media and at upcoming conferences. If we say we care about science, then we must take such issues of integrity and ethics head on.
CONCLUSION-FOR NOW
We agree with FRONTLINE, that “without access, accountability and peer-reviewed science, it will be difficult to prove to Flint residents their water is safe.”
But FRONTLINE apparently seems to be completely unaware, that the FACHEP faculty they have decided to shamelessly promote, are the ones who have routinely failed to meet that standard, relative to numerous unsubstantiated scientific claims in Flint 2016-2019. In this case, it is not the scientists and health officials at the EPA or the State of Michigan who need a lecture on communicating and conducting quality science, but FRONTLINE and FACHEP.
Stay tuned. We will keep asking the simple questions until we get answers.
Primary author: Dr. Marc Edwards
I’ve read the FACHEP study numerous times and I fail to see a stated hypotheses nor even an inference that the filters led to the LD outbreaks. They do however point out an important point regarding old infrastructure and the presence of “indigenous” waterborne opportunistic pathogens of which we should be aware of AND concerned. Clearly a thorough and more in depth study is warranted.
All be it should have been conducted at first reports of discolored, foul smelling, and distasteful water in 2014. Perhaps we would have a better comprehension of not only the cause of the LD outbreaks but, also other associated morbidity.
I have never heard of a 250 word scientific article and this one looks like something presented in a high school science fair.
The only other source typically associated with such a “study” might be a company selling and marketing a product (such as a filter). Perhaps might be some type of commercial motivation here?