10/05/2010 04:36 pm ET | Updated May 25, 2011

Justice by Whatever Name

James Zadroga's name will not be inscribed on the mournful memorial wall that is being erected at ground zero. But it is among the names of 9/11 heroes engraved on a plaque at police department headquarters in Lower Manhattan. And it is the name atop a massive Congressional bill that would provide long-term funding for research and compensation for thousands of people who became ill after being exposed to dust from the collapsed World Trade Center.

For some that disparity is a travesty. Others see it as irony. For still others, it is simply the painful reality that lies at the uneasy intersection of politics and science, where precious little can be proved with the absolute certainty most people expect and demand.

Zadroga was a veteran New York City police detective who had just arrived home on the morning of September 11 when he heard the news and rushed back to lower Manhattan. He spent hundreds of hours covered in the dust and developed breathing problems. When he died early in 2006, his death was considered a seminal case. For the first time, a medical examiner declared that a death was linked to exposure to the dust. When local members of Congress introduced a bill to help the thousands of responders and volunteers who were sick after working on the debris pile, they named it the James Zadroga Act.

But then things got strange. The detective's family asked that his name should be added to the official 9/11 memorial being built at ground zero. But when New York City's chief medical examiner reviewed his medical records, he determined that Mr. Zadroga did not die because of exposure to the dust but rather because he had injected himself with ground up prescription pain pills that clogged his lungs.

The painful controversy over what happened to Zadroga underscores the very real problems that have prolonged the anguish caused by the dust long after the dust itself has been washed away. Science can only tell us so much, and very little of that with the kind of absolute certainty most people want. In the case of the ground zero dust, more than 235 medical surveys and clinical studies have already been completed, but scientific investigators still don't know how much harm the strange mixture of gasses, ash and dust has caused and what damage it is likely to do in the future.

Because of the work of experts like Dr. Philip Landrigan of Mount Sinai's School of Medical, Dr. David Prezant of the New York City Fire Department and Dr. John Howard, the federal government's national 9/11 health coordinator, we do know that asthma cases have increased, as have sinus problems, acid reflux and traumatic stress. But those ailments are common in the northeast, and most studies (though not the fire department's) are based on self-reporting, which can be notoriously difficult to verify.

Still, consistency across many different studies, along with a century of accumulated knowledge about the effects of air contamination, makes it possible to argue that respiratory and gastrointestinal problems are plausibly linked to 9/11.

It is much more difficult to reach conclusions about disabling respiratory disease and catastrophic illnesses, like cancer, that can take many years to develop and can lead to death. To come up with conclusive evidence, medical investigators may follow victims for decades, comparing the incidence of disease to similar groups in the overall population who were not exposed.

Waiting that long does little for those who are worried that their exposure. Nor are they willing to trust the answers that eventually will be offered, even if they conclude that there is no added risk. As Kathleen Tierney, a professor of sociology and director of the Natural Hazards Center at the University of Colorado, Boulder, observed, "This is a group of people who perceive that they have been lied to practically from day one," when ground zero hazards were minimized. Once people perceive that they're not being leveled with, Prof. Tierney said, "it is very difficult to regain their trust."

Absent conclusive evidence about the long term impact of the dust, Congress, through the Zadroga bill, is taking a different tack. The bill would provide long-term funding for the continued screening, monitoring and treatment that will eventually allow investigators to get a real fix on the problem. But for now it simply presumes that a broad range of responder's illnesses were caused by the dust, and compensates victims.

Presumption has been used in other incidents of contamination, including veterans exposed to Agent Orange and workers involved in the Manhattan project. The drawback to this approach is that the number of covered diseases can continue to grow far into the future, as in the case of Agent Orange, which added several diseases just this year.

The Zadroga act went nowhere during the Bush administration, but its chances have improved not because the science is better but because Democrats control Congress. In July, a majority of House members voted for the bill but the legislation was presented in a way that required a two-thirds majority and so did not pass. Last week, Congress voted again, this time without any special maneuvering, and the bill was approved. In the Senate, Kirsten Gillibrand of New York has gotten a commitment from the leadership for the bill to be brought up without first going through the committee process as soon as Congress returns in mid November. The fight is likely to be rough, with Republicans raising doubts about the the $7 to $11 billion cost of the bill and the method Democrats plan to use to pay for it. The idea is to close a tax loophole that can favor foreign companies doing business in the U.S. Republicans may claim the measure will kill sorely needed jobs here.

President Obama has said he would sign a bill if Congress approved it.

It's not just Congress where the dust's toxicity has been questioned without reaching any firm conclusions. A federal judge in Lower Manhattan has overseen 10,000 individual lawsuits accusing New York City and its contractors of failing to adequately warn responders and volunteers of hazards in the air and provide dust masks that might have kept them from harm.

The judge, Alvin K. Hellerstein, knew how difficult it would be for any of the workers to prove their injuries were linked to the dust, especially when they were claiming that more than 350 different ailments. So before any scientific evidence for or against a linkage had been presented, Judge Hellerstein got both sides to agree to what eventually became a comprehensive settlement that could be worth around $700 million if more than 95 percent of the responders agree to participate.

The plaintiffs had until September 8 to decide. But only 50 percent had approved the package by then, so the deadline was extended to November 8, a week after the midterm elections.

If successful, both the legislation in Washington and the litigation in New York have the potential of finally providing a sense of justice and fairness that has proved elusive for nearly a decade.

There is a risk that sidestepping the scientific quest for conclusive evidence of a link between dust and disease would set a precedent for future environmental disasters where those involved could demand similar presumptions. And experts say that substituting presumption for proof on such a massive scale could actually increase responders' fears of diseases and ailments awaiting them.

Still, the Zadroga bill along with the court settlement may be the only fair responses at this time. As Dr. Howard, the 9/11 health coordinator, has said, "We in science can't give an answer right now." That leaves it to politics, and the law, to offer solutions.