I'm William Brangham and this is "Horizons."

On September 11, 2001, nearly 3,000 people were killed and thousands more left with physical and psychological injuries.

But not as immediately apparent, the long-term health impacts to the hundreds of thousands of people exposed to toxic contaminants.

Survivors have faced everything from cancer to respiratory disorders to PTSD.

On top of it all, some have had to wage a decades-long fight for some measure of justice.

A quarter of a century later, we look at how 9/11 continues to impact the health of survivors, coming up next.

♪ Narrator: Support for "Horizons" has been provided by Steve and Marilyn Kerman and the Gordon and Betty Moore Foundation.

Additional support is provided by Friends of the News Hour.

♪ This program was made possible by contributions to your PBS station from viewers like you.

Thank you.

From the David M. Rubenstein Studio at WETA in Washington, here is William Brangham.

Welcome to "Horizons."

As we commemorate the 25th anniversary of the September 11th attack on our country, we wanted to look at one of the darkest legacies of that day.

It's now believed that more people have died because of the toxic exposures they got from the 9/11 sites than were killed by the terrorists on that awful day.

When three different jets full of fuel were crashed into the World Trade Center towers and the Pentagon, they pulverized massive buildings full of electronics, plastics, asbestos and other toxic chemicals.

Thousands of first responders and volunteers, many without adequate protection, rushed to those sites to try and find survivors.

They dug through smoldering piles, some of which continued to burn for months, and worked there around the clock.

These areas were heavily contaminated with dioxins, heavy metals, PCBs, as well as many other chemicals known to cause cancer and respiratory problems.

And in the subsequent years, the toll on those people's health has been enormous, a tidal wave of people getting cancer of the blood and lungs, as well as lung and heart diseases.

And that says nothing about the psychological wounds.

Later in the program, we're going to hear from a construction worker who responded to the World Trade Center site and who has been instrumental in getting compensation for first responders.

But, first, we want to talk with two doctors who have been caring for people who were sickened by their exposure to those 9/11 sites.

Dr.

Michael Crane is the medical director of the World Trade Center Health Program at Mount Sinai Hospital in New York.

And Dr.

Benjamin Luft is the director and principal investigator of the Stony Brook World Trade Center Health Program.

Gentlemen, thank you both so much for being here.

I know the two of you know each other and have worked with each other and have collaborated over the years.

Dr.

Crane, to you first.

For people who don't remember what those burning sites were really like, can you remind us of the kinds of things that people were exposed to in the first days after the attack?

Well, I can certainly try.

To recreate that is to take a page out of the book of hell and show it to people.

So the towers came down, just as they said in the introduction, and there was fire everywhere.

There was pulverized dust in the air of all kinds.

And people knew that other individuals were trapped in there somehow.

So people from the neighborhood, police officers, firefighters, they raced into that pile, ran in there.

And in doing so, most of them had little or no protection at all.

They breathed in this toxic, hellish material, particles, asbestos fibers, pieces of fiberglass, concrete, some of it ground very small, others of it such that they would breathe it in and start to choke.

And they did this repeatedly.

They ran in and ran out, trying to save people.

And there was very little respiratory protection.

That came later.

But what you see in terms of the newsreels you're showing right now is what was there.

There's a police officer walking around looking like he's got a handkerchief over his face.

So there was next to no respiratory protection for the rescuers when this was starting.

There certainly was no cushioning them from the terrible, terrible emotional impact of this.

People walking into a pile and finding a crushed body still holding a baby picture.

Just unspeakable findings repeatedly and repeatedly.

And the reason they are heroes, William, is because these folks went back again and back again and back again.

They would not stop.

Not only responders, professional responders like firefighters, but people from the neighborhood racing in there to try and help save people.

Dr.

Luft, a similar question to you.

When we think of exposure to foreign agents, we think of dose, like the amount.

How much virus did you inhale into your lungs?

Or how much radiation were you exposed to?

In this case, it sounds like there were just such an incredibly complex amount of different kinds of exposures happening all at once.

That's right, William.

I think it's very important to realize that there were two major exposures that were occurring concomitantly.

One was the psychological exposure, the psychological trauma of people dying, people being at high risk, seeing body parts, their colleagues dying, which gave rise to a lot of emotional problems such as PTSD and depression.

And the work that we've done at Stony Brook, what we've uncovered or what we've discovered is that that type of psychological exposure has a memory of its own.

It's not a normal memory.

It's not the memory that you have in your brain, but it causes the body to change and various pathways to evolve.

The other type of exposure that they had was the physical exposure, the exposure, as Mike said, to the actual dust, the toxins.

There was the high, the extreme heat from the fires that were burning up plastics and other materials that released a lot of very toxic material.

And this enveloped the entire area.

Now, not everybody is exposed equally.

That's the nature of exposure.

Some people are lucky and they go to an area where it's not as intense and others go to areas where it's more intense.

But I think in a lot of the studies that we've seen of the diseases that subsequently occurred as a result of 9/11 exposure, there was a dose response, what we call in science a dose response, meaning that if you had a higher dose of exposure, you were more likely to develop certain diseases than if you had a very lower, much smaller response.

Dr.

Crane, just pick up on that.

So, looking back now, 25 years, what does the record show, broadly speaking, as far as the types of diseases and ailments that these people have come down with?

Well, I think Ben just put it very well.

You had, first of all, this enormous shock reaction, which we're still seeing the waves from today, PTSD and depression in particular.

And particularly, as some of Ben's research is showing, that as a population ages, those illnesses may predispose or open the pathway to cognitive disorders and dementia, in addition to the toxicity.

So that's an ongoing risk right there.

I mean, we had other disorders as well.

Certainly, people developed terrible gastroesophageal reflux and heartburn.

And that's been just a problem for so many of our patients so long.

Essentially, you know, they not only breathed it, they swallowed it down.

And it was irritative going down.

And the irritation then became chronic and was probably aggravated by all the stress.

The lung conditions, asthma is probably the easiest to deal with.

And they've developed plenty of that.

But we've had all kinds of lung diseases, some of which have led people to need lung transplants and cases of lung cancer.

So it's really... The old expression is, you know, the exposure through the book at the guy.

There was nothing, no organ system that went unpunished in this situation.

And fortunately, we've found that, and Ben has found as well, that many of the conditions actually responded to our treatment, and folks could live a relatively normal life.

But that fear that Ben was talking about, and that post-traumatic stress, never entirely goes away, and is sort of a lifelong issue.

Dr.

Luft, when you look back now, I know hindsight is 20/20, as the cliché goes, does what you have seen unfold over the 25 years make sense?

If you think back to people are exposed to this complex web of psychological and physical contaminants, as you described them, does it make sense that they have ended up the way they have?

I mean, I imagine there had to be no textbook you could have pulled off the shelf to say, "Here's how you deal "with a colossal disaster of this size."

I mean, does it all make sense to you now?

Well, now it makes sense, or at least we're able to decipher a lot of the manifestations of the disease.

We're able to kind of put together a story.

But I think, at the beginning, it didn't make sense, because, as you said, this was not something... this was a unique event.

This was not something that you could find in a textbook.

Each of the diseases, perhaps you could find some reference in the textbook as to something like asthma or gastroesophageal reflux or sinusitis.

But the way that these conditions manifested themselves initially were unique.

They were much more resistant to therapy.

They were much more severe.

And the... the... The things that you would normally think would occur, that after the acute response, that someone would either cough out this material, that the irritants would be gone, and the patient would get better.

Well, that did not occur.

And so that was kind of a surprise.

And then, as the diseases evolved, and they became more persistent, and they became giving rise to a lot of inflammation, and actually changing our DNA, causing mutagenesis and things of that sort, where our bodies were responding to them in a very pathologic manner, it gave rise to a whole host of new diseases that we originally would not have thought from just looking at it at time zero.

So we're now 25 years from the time of the disease, from the time of the onset of this catastrophe, and we're still being surprised.

We're still seeing new diseases.

And actually, one of the great strengths of this program, of the World Trade Center Health Program, is that we were able to follow these patients for such a long period of time.

And we've been able to see these diseases evolve.

And if we didn't do that, we would have probably attributed them to something else.

But we now know that this was truly due to their exposures at ground zero.

Brangham: Dr.

Crane, I'm watching you here, nodding along to everything that Dr.

Luft is saying.

Do you share that same belief that we just, again, you mentioned that we're now learning that this could also be complicit in evolving dementia.

Do you think we still don't have a full picture of what this tragedy has done to these people?

Crane: I absolutely agree with Ben.

He's spot on in all of this.

This population needs lifelong follow-up.

There's no question about it.

But may I say one thing about them?

They are remarkable people.

And when given a task, even a difficult task, with the idea that they can improve their health, they jump on it and seize it.

We have had an excellent response with this group to our stop smoking efforts.

At Sinai, I know our numbers are, I think less than 3% of the population still smokes.

And that is an interesting and important fact.

Because one of the things that I was terrified about was lung cancer.

I couldn't... I couldn't even begin to think that through back in the beginning.

And when I saw this response to the stop smoking efforts, it was so gratifying.

How they were protecting themselves, also from heart disease, of course.

And now, we don't see an elevated risk of lung cancer yet.

We have other cancers that are elevated like thyroid and prostate.

But that one, I think their efforts protected them from one of the worst of all cancers and kept that illness at bay.

So, give them the tools, and they will fight back.

Brangham: One tiny bit of good news to come out of this.

Dr.

Michael Crane, Dr.

Benjamin Luft, thank you both so much for your service and for your time today.

Thank you.

Crane: Pleasure.

Luft: Thank you.

As we have been hearing, working at those sites took an enormous toll on those who heard that call and rushed in to help.

For them, getting some measure of justice and compensation for their injuries and their medical bills has been a very, very long struggle.

One of the great champions of that struggle is John Feal.

On 9/11, Feal was working as a demolition supervisor at the site when an 8000-pound beam fell and crushed his left foot.

After nearly going bankrupt from his medical bills and watching other first responders get sick, Feal and others, including comedian Jon Stewart, pushed Congress to pass and subsequently update multiple bills, including the Zadroga 9/11 Health and Compensation Act.

John Feal's new book is called "I Will Follow You Anywhere," and it has just been published.

John Feal, so good to have you on the program.

Thank you so much for being here.

Can I ask you something?

You have been listening to the doctors' talk here.

When you and other first responders showed up on that site on 9/11, did you have any sense of the overall health hazard that you were putting yourselves into, or was that just not in your mind at all?

Well, one, thank you for having me.

I'm humbled.

Two, Dr.

Crane and Dr.

Luft, who I know very well, are the best of the best.

And they're very humble men.

And just so everybody knows, the 9/11 community is decimated with cancer.

And we have a higher survival rate than the general population against cancer because of the great doctors like those two.

As for your question, no, initially no.

But at the time, yes.

I mean, we all had sore throats, runny noses, bloody noses, didn't feel good, rashes.

We knew we were sick early.

We said we were sick early.

The federal government tried to demonize us, said we were making it up.

But then science caught up to us and gave us validity.

Yeah.

As you know, the current New York City mayor, Zoran Mamdani, has just started this process of releasing a whole series of files, 68 boxes of files, that were the air quality tests and contamination tests that the city had done back then, at the time, but did not make a lot of those public.

You were at this event earlier this week when there was an announcement about this.

Your partner in crime, Jon Stewart, was there as well.

I want to play a tiny bit of what Jon Stewart had to say that earlier this week.

Let's listen to that.

Stewart: We all knew who live in downtown Manhattan is that there was poison in the air and on the ground and in the windowsills and in your air conditioners.

Everyone knew.

And now it's very clear that the city knew as well.

And rather than take the steps to ameliorate the damage that that would cause to its citizens and to the people that were down there, they instead covered it up to get back to business as usual.

I mean, after fighting, Jon, all these years with the federal government, with members of Congress to also find out that the city itself was doing some of this.

How does that sit with you now?

Well, I'm not shocked.

I'm not surprised.

I am disappointed.

But there's no smoking gun in those 68 boxes.

I have seen those.

I work closely with those who are working to uncover this.

What bothers me the most, and what nobody really talks about, if the city would have came clean and said the air wasn't safe, the water wasn't safe, and they would have put in the place guards to keep the people of lower Manhattan safe and say, "Hey, "don't move back right away, "don't go open the 14 schools "that were in the geographic zone, "don't open Wall Street six days later," if they would have put in the place guards, maybe 10,000 people wouldn't have died.

Maybe it would only have been 5200 or 3600.

Maybe I wouldn't have had to make 400 trips to D.C.

I have 2400 meetings.

Maybe I only would have made 152 trips and 800 meetings.

What they did was escalate a serious issue into something that now cannot be fixed, because we are evolving for the worse.

And thank God we have doctors like Dr.

Crane and Luft that have to evolve with us as we get on into our older years and deal with these cancers.

You know, there's 155,000 people in the World Trade Center health program.

There's 57,000 plus people with a certified 9/11 related cancer.

That's one in three.

And again, we have a higher survival rate than the general population.

But if the city just would have came clean, we knew we were sick.

You didn't have to hide anything.

There was a lawsuit in 2010.

There was legislation in 2010, again, legislation in 2015, again in 2019, and again in April of this year.

You should have just came clean.

No one's going to get sued.

No one's going to jail.

There's going to be no investigation.

But for people like Rudy Giuliani, who's now sick and trying to get into the World Trade Center health program, or Governor Pataki, who has serious respiratory illnesses, who said it's from 9/11, it's karma.

It's full circle.

And these are the men who denied that everything was great and the air was safe, the water was safe, and get on with your life, let's show the terrorists we're not scared of them, yada, yada, yada.

But at the end of the day, human life took a backseat to the almighty dollar, and we don't value human life like we used to.

Brangham: John, you were, as I mentioned, instrumental in getting some programs in place to provide compensation for people, to get them ongoing screening, as you're saying, and that's probably a major contributor to why they're doing better from these cancer rates, because you're spotting them early, etcetera, plus the compensation for people's medical bills.

All that said, 25 years later, how are the people that you are in touch with doing, the first responders that you're... in your network, how are they?

Dying.

If it's not cancer, it's COPD or pulmonary fibrosis or asthma or GERD.

And, you know, people just think GERD is acid reflux.

It's literally... The GERD that we have in the 9/11 community, most likely it would turn to Barrett's esophagus and then to throat cancer.

It's pretty bad.

I suffer from it.

I don't take pills and medicine for it.

I drink apple cider vinegar.

But everybody's got a serious illness that they have to live with.

On top of that, most of us were diagnosed with post-traumatic.

That itself is a battle every day.

I know, John, you said, and this is not to make light of anything about PTSD and the trauma that it can cause for people, but you told me earlier that you feel like some of the trauma that you experienced has been the engine, the power that got you through decades of fighting for justice.

Is that right?

We have about a minute left.

Is that right?

You really feel like some of what you went through gave you the fire to fight?

Absolutely.

I was diagnosed by four doctors with post-traumatic.

I did therapy for two and a half years.

It means I've been through something.

I came out the other side.

I believe if you post-traumatic, it will swallow you and engulf you.

I believe if you embrace it, you can use it as your sword and your superpower.

I see better.

I hear better.

I feel better.

And I understand people's pain better.

And it allows me to do my job better in advocating for the 9/11 community and the veteran community, where Jon and I now both are active in that.

So, you know, anybody who is at home this week, two days away from the Day of Remembrance, if you need to talk, you want to talk, call me, e-mail me.

You know how to get in touch with me.

John Feale, again, I cannot thank you enough for what you did on 9/11 and for the decades of legislative fighting to get justice for all the people who stepped up to serve their country on that awful day.

Really appreciate talking to you.

Thank you so much for being here.

Thank you for having me, sir.

I'm humbled.

And that is it for this episode of "Horizons."

Thank you so much for watching.

We'll see you next week.

Narrator: Support for "Horizons" has been provided by Steve and Marilyn Kerman and the Gordon and Betty Moore Foundation.

Additional support is provided by Friends of the News Hour.

♪ This program was made possible by contributions to your PBS station from viewers like you.

Thank you.

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