Health Effects from MTBE in Gasoline by Professor Peter M. Joseph, Ph.D. University of Pennsylvania School of Medicine Philadelphia, PA 19104 Telephone: 215-662-6679 email: joseph@rad.upenn.edu June 15, 1996 SUMMARY MTBE is a chemical that is being put into gasoline under orders of the federal government in certain regions of the country. Many people find that it is causing them various kinds of illness. The symptoms can be either respiratory, neurological, cardiac, or allergic. Respiratory means any part of your respiratory system can be affected, including sinuses, nose, and throat, and can cause cough or trouble breathing. Asthma especially has been made worse by this problem. The neurological symptoms can include insomnia, anxiety, dizziness, nausea, headache, attention deficit disorder, or heart palpitations. The allergic symptoms include watery or itchy eyes and skin rash. The easiest way to determine if you have this problem is to travel to a region of the country where MTBE is not required to be in all gasoline and see if your condition improves. In many cases, people find that their symptoms get worse at night and on dark cloudy days without rain, but get better when the sun is shining. 1. What is MTBE? MTBE means Methyl Tertiary Butyl Ether. It is a special kind of ether and is known to have effects on the brain. It contains oxygen inside each molecule, so it is used to add oxygen to gasoline. For this reason it is called an "oxygenate". The purpose of oxygenating gasoline is to reduce the amount of carbon monoxide (abbreviated CO) gas that cars produce. Carbon monoxide is a poisonous gas produced by automobiles, so the EPA (Environmental Protection Agency) is trying to reduce it to improve our health. The EPA says that MTBE reduces CO by at most 20%, but a recent review by government scientists indicates that CO is reduced by at most 5-10%. That small reduction is very unlikely to be of help to anyone. MTBE is one component of the new so-called "reformulated gasoline" (abbreviated RFG). RFG must, by definition, contain the equivalent of at least 11% of MTBE. However, during the last three winters certain regions of the country have been required to have gas containing 15% MTBE. Those regions include New York City and surrounding regions in Connecticut and New Jersey, Philadelphia and its surrounding four suburban counties, Baltimore, Washington DC, and most cities in California. (There may also be other cities that I am not aware of; ask your local EPA office for details.) This was done from November 1 to March 1 during the winters of 1992-93, 1993-94, and 1994-95. Since January 1, 1995, all of these regions plus many more have been required to use RFG all year round. In most places, RFG will contain 11% MTBE, although in a few states (Washington, Oregon, Montana, and Minnesota) ethanol is used as the oxygenate rather than MTBE. Ethanol, also called ethyl alcohol, is exactly the same kind of alcohol that is used in alcoholic beverages. Again, your local EPA or state Department of Environmental Protection is the best source of information for your area. In December 1994 Pennsylvania canceled the MTBE program in all of Pennsylvania except for the 5 county Philadelphia area. However, in some areas of Pennsylvania gasoline with MTBE was still being sold even though it was not required. It may happen that the EPA will soon require that Pittsburgh use RFG again. 2. What are the health concerns for MTBE? The EPA and others have done many animal experiments with MTBE. At high doses, larger than those you would normally encounter, it basically makes the animals drunk. So far, most of the animal experiments do not indicate any really bad effects from doses you are likely to receive in the air. However, some people react badly to MTBE, usually with headache, nausea, dizziness, or other signs of illness. These people will experience these problems when driving in heavy traffic or especially when pumping gasoline. A famous scientist in Italy, Dr. Cesare Maltoni, has conducted experiments in which he showed that rats got cancer when exposed to MTBE. Some cancer experts at the EPA agree that MTBE should be classified as a carcinogen. It was not so many years ago that people thought that benzene was safe, and in fact, some automobile mechanics used to wash their hands in it. Benzene is a chemical that used to be very common in gasoline, but now we know that benzene really does cause cancer. In fact, one of the goals of the RFG program is specifically to reduce the amount of benzene in gasoline to less than 1%. It is interesting to note that the 1990 Clean Air Act, which requires the use of either MTBE or some other oxygenate, also lists MTBE as a hazardous chemical whose presence in the environment should be reduced! For example, it is known to be very toxic when present in drinking water. Unlike normal gasoline, it easily dissolves in water and so is practically impossible to remove once it gets into the underground water supply. It is also interesting to compare the toxicities of benzene and MTBE. EPA regulations require that if certain quantities of either substance are accidentally spilled, they must be reported. EPA regulation 40 CFR 302 (CERCLA Section 102) requires that any spill of more than 1 pound of MTBE must be reported, whereas only spills of 10 pounds or more of benzene must be reported. This implies that the EPA thinks that MTBE is 10 times more dangerous than benzene. In RFG gasoline they specifically require that benzene be limited to less than 1%, whereas they nevertheless require that RFG contain 11% MTBE or equivalent. 3. What other chemicals are involved? Theoretically, MTBE in your gas tank should burn up inside your car's engine and leave no residue. However, no automobile is 100% efficient, so some MTBE does come out of the exhaust. The exact amount probably depends on how new and well tuned your car's engine is. Old cars usually emit much more pollution than new cars. In addition to MTBE, automobile combustion also produces another chemical, called formaldehyde, in the exhaust. Formaldehyde is known to be toxic, and is considered to be a major source of air quality problems and illness when indoors. For example, certain types of cheap wood (plywood, particle board) are known sources of formaldehyde. The amount of formaldehyde emitted when MTBE is in gasoline is definitely higher than without MTBE, although the exact amount is hard to pin down. Measurements in Hartford, Connecticut indicate an increase of roughly 50%. Measurements in a tunnel in San Francisco showed an increase of 38%. Once the MTBE emerges from the tailpipe, it enters the atmosphere and we breath it into our bodies. It circulates in our bloodstream and enters all of our body's organs, including the brain, liver, developing fetus, etc. The liver converts it into formaldehyde and also another chemical called tertiary butyl alcohol (TBA). In most people it does this within a time span of one to two hours. Formaldehyde is known to be a toxic chemical that converts into formic acid and affects the brain. As for TBA, the human body is not well equipped to detoxify TBA, and it requires approximately 1 or 2 days for it to be eliminated. During this time you may experience symptoms from the TBA in your body. You should understand that TBA is different from the kind of alcohol in alcoholic beverages; that kind is called ethanol. The healthy human body can process and eliminate ethanol much more easily than TBA; that is why a person with a lot of ethanol in his blood does not remain drunk for more than a few hours after he stops drinking. When the MTBE is in the air, another chemical reaction also occurs; it can be converted into a chemical called tertiary butyl formate (TBF). The EPA and other MTBE proponents have totally ignored TBF. This is tragic since it is extremely irritating to the respiratory system and is probably responsible for many of the symptoms that people are experiencing. Very little scientific information is known about the toxic properties of TBF. However, it can be purchased as a research chemical, and its manufacturer gives this information on its toxic effects: ACUTE EFFECTS HARMFUL IF SWALLOWED, INHALED, OR ABSORBED THROUGH THE SKIN MATERIAL IS EXTREMELY DESTRUCTIVE TO TISSUE OF THE MUCOUS MEMBRANES AND UPPER RESPIRATORY TRACT, EYES, AND SKIN. INHALATION MAY BE FATAL AS A RESULT OF SPASM, INFLAMMATION AND EDEMA OF THE LARYNX AND BRONCHI, CHEMICAL PNEUMONITIS AND PULMONARY EDEMA. SYMPTOMS OF EXPOSURE MAY INCLUDE BURNING SENSATION, COUGHING, WHEEZING, LARYNGITIS, SHORTNESS OF BREATH, HEADACHE, NAUSEA AND VOMITING. TO THE BEST OF OUR KNOWLEDGE, THE CHEMICAL, PHYSICAL, AND TOXICOLOGICAL PROPERTIES HAVE NOT BEEN THOROUGHLY INVESTIGATED. So, TBF is a highly toxic chemical of the type known as a "respiratory irritant". Other chemicals with similar toxic properties are known to induce asthma attacks as well as inhibit the body's natural defense against respiratory infections, such as cold, flu, pneumonia, etc. For example, the New York Times reported on January 17, 1995 that the flu was exceptionally bad in New York City and parts of Connecticut, but not in upstate New York. The areas that had a bad flu season, such as Philadelphia, were exactly those areas that have had 15% MTBE for the last three winters. Other cities, such as Boston, which just got MTBE in January were not as hard hit because those people have not been exposed to it as long as New York City. It is important to understand that you do not have to be in a car or at a gas station to be affected by these chemicals. They will be in the air throughout the polluted urban environment, so you can experience symptoms while at work, at home, or even in the hospital! 4. Who is affected? The key idea is chemical sensitivity. Some people are much more sensitive to certain chemicals than others; this is similar to being allergic. This effect is known to exist, but the medical facts are not well understood. Unlike allergy, it can not usually be treated with antihistamines or other drugs. Evidently most people are not sensitive to these chemicals or else we would see more people being sick from MTBE. However, it appears that approximately 5 to 10 percent of the people are sensitive to at least one of the previously mentioned four chemicals. It is possible to be sensitive to more than one. It is well known from experience in the chemical industry that someone who is not sensitive can become sensitive to a given chemical by being repeatedly exposed to it over a long period of time. This seems to be happening with MTBE and its byproducts (TBF), because with each passing month more people are complaining about sensitivity symptoms. This can happen to anyone, but it appears to be most prevalent in people over the age of 40 (especially women) and perhaps in children with allergies or asthma. Automobile mechanics and gas station workers who must breath MTBE and TBF fumes all day are showing more and more signs of illness. Some have become so sick they have been forced to quit their jobs. 5. What are the symptoms that people are reporting? The symptoms can be roughly divided into four categories: respiratory, neurological, allergic, and cardiac. Respiratory symptoms are due to irritation of the tissues in lungs, bronchial tubes, and nasal passages. The result feels much like a cold. Some people report sudden difficulty in breathing; that is a serious problem for which they should see a doctor as soon as possible. (Also, it is possible that the irritation produced can inhibit your body's natural defense against a true cold, although this has not been proven.) One common symptom is a long lasting cough that never seems to get better. Another common symptom is chronic inflammation of the sinuses. Also, many people with this problem just feel terrible, sort of "sick all over". A sense of hot flushing in the skin around the head and neck is common. Neurological symptoms include nervousness, dizziness, spacey feeling, "lightheadedness", nausea, insomnia, and headache. Some people describe this as like having a cloth wrapped around your brain, or being drunk. Some people have trouble with short term memory. A common problem is difficulty in concentrating on complex tasks, such as reading a complicated newspaper article or paying attention to traffic while driving. It is possible that this is the cause of the recent increase in attention deficit disorder (ADD) in schoolchildren in MTBE regions of the country. The allergic symptoms include watering in the eyes, discharge of fluid in the throat, or skin rash. Some people are reporting heart palpitations from exposure to auto exhaust or on bad weather days. There have also been many reports of apparently healthy young athletes dying of unexpected heart attacks, especially on cloudy days. If you experience this sort of problem, especially late at night, you should consult a doctor. Be sure to show him or her a copy of this report, because most doctors are not aware of this effect. The symptoms you will feel will depend on which of these chemicals you are sensitive to. Actually, the details of this problem are not known, so it is hard to be more specific than this. 6. How do you know if you have this condition? The respiratory symptoms are very similar to other diseases, especially to asthma or the common cold. The neurological symptoms could be caused by some other serious medical problem, such as anemia or brain tumor. You should get checked out by a doctor if you have these symptoms. There is no specific test for the MTBE condition. The best way to determine if you have the MTBE problem is to take note of what factors influence it. It is bound to be worst when in the center of a big city or near a major highway. If you can travel to another part of the country that does not require MTBE in gasoline, you can see if your symptoms go away. 7. Where is MTBE being used? This is complicated, since in some states it is practically required in all gasoline, in some states it is required only in certain counties, while in other states where ethanol is being used as the oxygenate there is practically no MTBE at all in the gasoline. States using only ethanol for oxygenate include Alaska, Minnesota, Montana, Oregon, Washington, and parts of Colorado. So far, most of Pennsylvania except for Philadelphia, Delaware, Chester, Montgomery, and Bucks counties are not supposed to have mandatory MTBE. Obviously, if you want to escape MTBE it would be good to go to a very rural area. New Jersey, Connecticut, and Massachusetts, including their shore areas, have MTBE or some other oxygenate. However, some people have reported they feel better at some of the more isolated areas of the Jersey shore, such as Cape May. North Carolina has banned all oxygenated gasoline specifically because of bad health effects from MTBE, although MTBE is still being used as an octane enhancer in high octane grades of gasoline. If you are not sure whether MTBE is being required in your area, there are two things you can do to find out. The simplest is to just smell the gasoline at the pump, since MTBE has a very strong and distinctive odor that most people find very obnoxious. Another source of information is your local EPA office or state office of environmental protection. 8. Weather Effects. Weather plays a very important role in the symptoms of many people with this problem. Many people find that their symptoms get much better when the sun is shining and worse at night or on dark cloudy days when it is not raining. This mauy be because sunlight destroys TBF, although this has not been proven. On the other hand, if it is cloudy but raining then people usually feel better because the rain clears the air of many pollutants, including MTBE and TBF. However, there are some people who do not get better when the sun is shining and yet are convinced that their symptoms are related to MTBE because they feel better on travel to regions without MTBE gasoline. This must mean they are sensitive to some other chemical whose nature has not yet been determined. 9. What about pumping gas? Some people feel especially ill when they are pumping gasoline, and try to avoid it at all costs. The symptoms, which usually include dizziness or wooziness, can last for several hours. In several cases people have had serious automobile accidents soon after pumping MTBE gasoline. If you get symptoms only during or soon after buying gasoline, you might try to find a brand without MTBE. For example, on the east coast Getty Oil Co. usually uses ethanol instead of MTBE in the winter months. However, during the summer the EPA has forced them to use MTBE instead of ethanol. 10. How do we know about this problem? MTBE was first put into gas at a high level in Denver in 1988-89. The EPA set up a "hot line" on which to take complaints. They said there were very few. However, some sensitive people living in Colorado insist that the EPA never listened to their complaints; these people have been suffering ever since! In the winter of 1992- 93, MTBE was also introduced into Alaska. In the city of Fairbanks, there was a huge rise in all of the previously mentioned symptoms with almost half of the city complaining. The problem was so obvious that the EPA hired doctors from the Centers for Disease Control (CDC) to investigate. The CDC study implied that MTBE was causing the illness. Governor Hickel of Alaska ordered all MTBE out of the state, and the symptoms promptly disappeared! The CDC then did a similar study in Stamford, Connecticut and found similar problems. Furthermore, they found that the intensity of the peoples' symptoms was directly related to the amount of MTBE in their blood. In Missoula, Montana, MTBE was used as an oxygenate in 1992-93. There were many reports of the symptoms discussed here. Two-thirds of the doctors there noticed that their asthmatic patients got worse. A citizens action group organized opposition and managed to get MTBE removed from their city. The result was a dramatic decrease in these symptoms. The EPA, however, rejected the CDC and Missoula findings and refused to allow the CDC to conduct any more investigations. The EPA is now pushing for this program to be expanded to even more states. You can call the EPA hotline at 800-621-8431 to protest this policy. However, do not expect to receive a polite answer. The most important step is to write to your senators and congresspersons and ask them to change the law that requires that we use this chemical in our gasoline. In 1995, the White House Office of Science and Technology Policy appointed several high level committees of scientists to look into this problem. The committee on air pollution concluded that the use of MTBE and other oxygenates has provided very little, if any, improvement in the air quality as normally determined. (They did not consider the tremendous increase in TBF in the air!) The committee on health effects wrote a rather ambiguous report in which they admitted that people with allergies and older people may be more sensitive and recommended that more research be done. They did not consider TBF or the tremendous increase in asthma in cities where MTBE is being required. 11. Asthma The proponents of MTBE will point out that it has been used in gasoline since 1979 with, they say, "no problems". However, asthma has been increasing dramatically over exactly that time span. The Philadelphia Inquirer on June 11, 1995 ran an article entitled "Asthma's Grip Baffles the Experts", in which they said that asthma deaths in Philadelphia had tripled since 1981, and that the cause was unknown. The article made it clear that we are now living with a real epidemic of this terrible, sometimes fatal, disease. Several newspaper reports from New York City indicate really huge increases in some parts of the city, with one school in the Bronx showing one- third of the students with asthma. Recent statistics from the Philadelphia Department of Health indicate a 43% increase in asthma office visits from 1993 to 1995. Several of the asthma deaths of teenagers reported occurred in the middle of the night, when TBF levels are predicted to be highest. In view of the highly toxic effect that TBF has on the respiratory system, the use of MTBE in gasoline has to be number one on the list of suspected causes. Practically all schools in the Philadelphia, New Jersey, Connecticut, and New York City regions are reporting huge increases in asthma over the last few years that the asthma doctors are totally unable to explain. In Stamford, CT, the doctors noticed that the increase is worst for those children who live near Interstate I-95 and who play under the overpasses, obviously breathing a large amount of car exhaust. We desperately need to get more statistics on the increase of asthma in school children, but so far all school system administrators contacted have refused to cooperate. If you would like more detailed information on asthma and MTBE, please contact me. 8. What can be done about this? In many states where MTBE has been used, citizen action groups have formed to oppose MTBE. In New Jersey a group called "Oxybusters" has accumulated over 13,000 petition signatures, and in Pennsylvania so far 2000 signatures. However, government officials have so far ignored these petitions. That is why a letter to your elected officials is more effective than just signing a petition. Another important activity is to somehow educate the public on the importance of this issue. This can be done by writing letters to your local newspaper. Do not expect doctors to be sympathetic, because they are usually very resistant to the suggestion that there is a new disease that they know nothing about. This is true even for those who suffer from it personally. However, after many months of seeing data and evidence they may eventually come to believe that we are right. Perhaps the most important action you could take at present would be to convince a school nurse to tabulate statistics on the number of asthmatic children under her or his care over the last six years. If you find a nurse willing to do that, please have the nurse contact me at the Hospital of the University of Pennsylvania for details of statistics needed. The following telephone numbers will reach Oxybusters or other citizens action committees against MTBE: Connecticut: 203-358-0780 Maine: 207-883-4691 New Jersey: 609-275-7080 Pennsylvania: 610-352-7072 Texas: 512-578-7567 If you are not in or near one of these areas, please call the National Oxybuster Hotline phone number: 713-905-7567 Call Dr. Peter Joseph, Hospital of the University of Pennsylvania 215-662-6679 for more information or to help in this matter.