Photograph by Mark Thiessen, National Geographic

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A homeowner in Granville Summit, Pennsylvania, holds up a glass of tap water containing high levels of methane, a concern for those who live near fracking sites. Studies examining health effects from fracking are under way as New York State considers whether to allow the practice.

Photograph by Mark Thiessen, National Geographic

Health Questions Key to New York Fracking Decision, But Answers Scarce

As debate rages in New York State over whether to allow fracking, researchers are attempting to shed light on its public health effects.

New York State's review of high-volume hydraulic fracturing has taken more than four years—and it's not over yet.

Right now, all eyes are on the state's health commissioner, Nirav Shah, who has said that he will tell Governor Andrew Cuomo within weeks whether the Department of Environmental Conservation's plan for "fracking" would be sufficient to protect human health. Then it's up to the governor to make a final decision on whether to permit the technique, which involves pumping large volumes of water mixed with chemicals into rock far underground in order to release natural gas. (See related quiz: "What You Don't Know About Natural Gas.")

The combination of hydraulic fracturing with horizontal drilling has ushered in a new era of natural gas production in the United States, particularly in states such as Pennsylvania and Texas. New York, which sits on part of the same shale formation that has fueled Pennsylvania's gas boom, issued a moratorium on high-volume hydraulic fracking in 2008.

Shah's decision isn't likely to settle the contentious debate, but the state's inclusion of health effects in its decision-making process adds relatively new complexity to an already thorny issue. While several studies have examined the environmental impact of fracking—from its ability to cause earthquakes to the potential contamination of drinking water by methane gas or industry fluids—the direct impact on health has received only limited scientific attention so far. The chief concerns: how drinking water, air quality, and ambient noise levels might be affected by the processes and chemicals used in fracking, and in turn how they might affect human health, said Robert Jackson, a professor of environmental sciences at Duke University. (See related stories: "International Agency Calls for Action on Natural Gas Safety" and "Good Gas, Bad Gas")

Some health experts say there simply isn't enough evidence yet to judge whether the drilling process could harm those who live or work near natural gas wells. The studies on health outcomes that have been done are small and not very rigorous, said Madelon Finkel, professor of clinical public health at Weill Cornell Medical College in New York City. "People are coming in and saying, 'I have this, this and this, and I didn't have that condition before fracking, so it must be from that,'" she said. "Without properly done epidemiological studies, it becomes a he-said, she-said [situation]. We really do need well-designed studies to focus on a multitude of factors." Finkel and her colleagues are trying to obtain funding for a study of health outcomes in southwestern Pennsylvania. (See related story: "Methane on Tap: Study Links Pollution to Gas Drilling.")

A lack of money has been one of the obstacles to studying the health effects of fracking, said Jackson, who co-authored 2011 research and policy recommendations for fracking. Another stumbling block has been determining what exactly to study. An uptick in asthma symptoms, for example, would be apparent very soon after changes in air quality. But other conditions, such as cancer, would take years after exposure to develop, were they to occur, Jackson said. And some conditions are so rare that it would require very large studies to detect any increase.

Some larger, more rigorous studies are planned or in progress. One of them is from Pennsylvania-based Geisinger Health System, which treats hundreds of thousands of people who live near the Marcellus shale, the huge underground rock formation that feeds Pennsylvania's shale gas production. (About 20 percent of the Marcellus formation lies in the southwestern part of New York State.) (See related story: "Natural Gas Nation: EIA Sees U.S. Future Shaped by Fracking.")

Geisinger has the advantage of longtime electronic medical record use. Researchers are hoping to use that data, along with records from Pennsylvania's Susquehanna Health and Guthrie Health, and the state's department of health, to study a variety of health outcomes. Early studies are focusing on asthma exacerbations and pregnancy outcomes, wrote Brian Schwartz, a professor of environmental health sciences at Johns Hopkins University who is involved with that research, in an email.

Geisinger's records are valuable because they cover people living over a wide swath of the state and include detailed health information from before and after drilling started in 2006, wrote Schwartz. Such a study "allows us to look at many different health outcomes across a large geography and over a long period of time in a way that is relatively efficient," he wrote. In addition to examining asthma control and pregnancy outcomes, researchers from Geisinger and other institutions are planning other health studies based on the same data. The entire initiative could take as long as 20 years, and results from the earliest studies aren't due for at least a year.

Health-focused studies also are being conducted by the U.S. Environmental Protection Agency and the University of Pennsylvania. But none of this research will be completed in time for Shah to weigh their final results in his review process. Researchers say some of the findings from the studies in progress would likely be applicable to all or most fracking sites, while others—say, those for air quality, which would depend on wind patterns—might be less easily generalized.

Karen Moreau, executive director of the New York State Petroleum Council, a division of the American Petroleum Institute, said the real health threat in the region of New York known as the southern tier, where the drilling would take place, is unemployment. Fracking would bring much-needed jobs and money—and the health benefits associated with wealth—to the area, she said.

As for any signals of health problems from other areas, "we certainly don't see anything that would suggest the kinds of studies that some organizations are proposing," Moreau said. "This is a decades-old energy development method with an outstanding record of safety and environmental protection." (See poll: "Has Fracking Changed Our Energy Future for Better or Worse?")

Cuomo hasn't said when he will make a decision on fracking in New York. When—and if—conclusive health-study results come in, and what they will reveal, is up in the air. "I think the stakes are very high," said Weill Cornell's Finkel. "If you're going to drill, you have to take into account the safety of the environment and of health before you drop your well." And at this point, she said, "we are not truly understanding the consequences."

This story is part of a special series that explores energy issues. For more, visit The Great Energy Challenge.