The state Department of Health has completed the first phase of a study on the health effects of sugar cane burning on Maui, and, while the preliminary results hint at people suffering ill effects downwind of cane burning, the study won't be complete until Maui Memorial Medical Center and island health clinics allow researchers access to their records, said Dr. Lorrin Pang of the state Department of Health.
The preliminary results come from a nine-month study of islandwide pharmacy prescriptions for respiratory and eye irritation ailments suspected of being caused by people being exposed to cane smoke, said Pang, the Maui District health officer.
Those results compared the number of prescriptions given to people downwind and upwind of cane burnings that were completed before 6 a.m., when it was reasonable to believe people were at home during the burnings. This included north Kihei and Maalaea, where prevailing trades tend to carry the smoke, he said.
A cane fire burns in Maui’s central valley in 2011. The state Department of Health has completed the first phase of a study on the health effects of cane burning on Maui. While natural-occurring volcanic haze appears to trigger more widespread respiratory and eye irritation cases, the study suggests that people downwind of cane burning do suffer ill effects, but not dramatically more than when there’s no sugar cane burning.
The Maui News / MATTHEW THAYER photo
A cane fire lights up the morning sky in 2011.
The Maui News / MATTHEW THAYER photo
Obtaining highly detailed information on sugar cane burning is a requirement of the plantation's cane-burning permit issued by the state Department of Health. By plotting the exact locations of burned fields, wind speeds and the addresses of pharmacy customers on Google Maps, Pang's team, which included doctoral students from the University of Hawaii at Hilo School of Pharmacy, found that on burn days, 76, or 13 percent, out of 576 cases reported were from people in downwind zones. On nonburn days, 75, or 11 percent, of 680 cases islandwide were from the corresponding downwind areas.
The slightly higher percentage of people affected by cane smoke in the area suggests an ill effect of cane smoke, but it can't be shown to be statistically significant, Pang said.
He also pointed out that there were more total "cases" on nonburn days, probably because burning is not permitted when there is volcanic haze, or "vog," from the Big Island, and burning also cannot occur during cold, rainy weather, which might bring on respiratory symptoms.
Alexander & Baldwin Senior Vice President Meredith Ching said company officials have not seen the Health Department's study and were unable to comment Wednesday. A&B is the parent company of Hawaiian Commercial & Sugar Co.
The study comes at a time when there has been escalating public demonstrations and growing concern about the health effects of cane smoke. Pang indicated that the study was aimed at trying to provide hard information on this often emotional issue.
The impetus for the study was a University of Hawaii-Hilo student, Christina Mnatzaganian, who was doing her "community project" as part of her residency, said Pang. She wanted to do her project on cane burning and received approval from the Health Department. Mnatzaganian, who received her pharmacy doctorate in Arizona, earned her residency and is currently on the faculty of UH-Hilo, he said.
Irene Bowie, executive director of the Maui Tomorrow Foundation, said further study of the health effects of cane burning should be done, and more discussion of the issue is needed.
"I feel that with the current heated conversation going on in our community regarding cane burning, it only makes sense to take a serious look at possible health effects," she said. "I'm grateful that Dr. Pang and the University of Hawaii have begun this study, and Maui Tomorrow wants to do what it can to facilitate the discussion.
"If scientific evidence shows that Maui's children and elderly, in particular, are being seriously impacted with higher rates of respiratory illness by the practice of cane burning as a method of harvesting, then perhaps it's time to consider another form of harvesting, as is done in Australia and Brazil," she said. "Perhaps the study will show other results, but in order to have a rational conversation about this practice we first must have a health study conducted."
Bowie said Maui Tomorrow is working on facilitating a meeting later this month with Pang, health care officials and elected officials to discuss the study. She said she would not be opposed to having HC&S officials included as well.
She said she believes that the first meeting would probably be a private gathering, then followed by a public meeting.
HC&S General Manager Rick Volner Jr., who was traveling Wednesday and unavailable for comment, has said previously that HC&S acknowledges that any smoke can aggravate pre-existing respiratory conditions, such as asthma. But he said cane burning as a pre-harvesting method is necessary to reduce the amount of plant material harvested as well as to concentrate the amount of sugar in the cane.
Cane burning helps keep the 38,000-acre Maui sugar plantation viable and maintain 800 jobs, Volner has said.
Pang said that in addition to the information his team already has received from island pharmacies, he would like to see other types of data, including clinical cases that would come from Maui Memorial Medical Center's Emergency Room and from clinics such as Kaiser Permanente and Maui Medical Group.
"We can plot the address of exposure on our same maps of burn versus nonburn days," he said. "While those groups initially agreed to be part of this study, they now have raised administrative issues for not participating," Pang said.
Officials have raised objections to patient privacy concerns, conversion to new electronic medical records and to the cost of overtime to have employees provide the data to researchers, he said.
Pang said the research study has been cleared of the privacy concern by both the University of Hawaii and the Department of Health ethical review committees and said that because information is available in computer systems, it would not take that much employee time to provide the information to researchers.
"It's worth it," he said.
Maui Memorial spokeswoman Carol Clark said: "We appreciate Dr. Pang's study and do see the value in it. However, as our primary focus is patient care, our resources for researching data are limited. We will consider looking for ways to facilitate information needed for the DOH study going forward and as our resources allow."
Kaiser spokeswoman Laura M. Lott said Kaiser understands Pang's need for information for the study and wants to help public health research.
"Unfortunately, we are not allowed to violate the privacy of our patients," she said.
Revealing the name and address of patients violates their privacy, and "that's against federal law," Lott said.
She added that there are other ways to get the same information, such as setting up a website and asking people to come forward and voluntarily share information about their exposure to cane smoke.
"It's their information to give," she said. "We can't do that without breaking consent."
Dr. Bill Mitchell, president and chief executive officer of Maui Medical Group, said his group "can work with Dr. Pang to develop data to look at this question," but he said he has not had a recent discussion with him about the issue.
"I would be concerned about the statistical validity of this type of information," Mitchell said, but he would like to discuss the matter further with Pang. "I am a lung specialist at Maui Medical Group. I see an even stronger relationship (of respiratory cases) with vog. But you can't do much about Madam Pele."
* Brian Perry can be reached at firstname.lastname@example.org.