Energy. Environment. Economy.

A Link Between Heavy Drilling and Illness? Doctors Search for Solid Answers

Susan Phillips / StateImpactPA

Edna Moten says nearby gas drilling has polluted her water and air.

Doctors in heavily drilled areas across Pennsylvania are starting to see more patients who report symptoms they think might be related to gas activity.  But with all the talk about health concerns and Marcellus Shale, what are the links between the two? And where does a doctor turn for answers? For this story, we spoke to several doctors who expressed frustration with trying to treat suspected shale related health impacts. This is the story of one such doctor’s quest for solid information on how to help her patients.

The Plastic Surgeon Who Makes Housecalls

Washington County’s village of Rae has only about 12 houses, and it’s hard to find on google maps. This is the heart of Pennsylvania’s shale country. The first Marcellus well was drilled in Washington County back in 2004, and today, there are 342 active gas wells registered with the state Department of Environmental Protection. Rae is surrounded by natural gas wells. Seven are within less than a mile.

Doctor Amy Pare doesn’t usually make housecalls. She’s a plastic and reconstructive surgeon from suburban Pittsburgh. But she has patients in this tiny town with some mysterious symptoms.

Edna Moten is one of them. She’s 90 years old and has lived in her one-story clapboard house for more than 50 years. She leans out of her screen door as Dr. Pare leaps out of the car and charges up her stairs.

Susan Phillips / StateImpactPA

Edna Moten's house in Rae, Pa.

Inside, a television has on the local Pittsburgh news. An overwhelming chemical smell hits you as soon as you step in the front door. Immediately it makes me feel dizzy, my head aches, and I feel nauseous.

Doctor Pare is here because she’s worried about Moten’s drinking water.

“Now are they providing you with water now, or no?” asks Dr. Pare. The ‘they’ is one of the gas companies. Edna says they’re not giving her water. But she is getting clean water delivered from a donor.

Sometimes if residents think drilling has contaminated their drinking water wells, gas companies will provide them water while they check it out. The water gets delivered weekly into what’s called a “water buffalo”, a large plastic container that sits on the front lawn. But no one in Rae has one. Nearby drillers say the water problems are not related to any of their activity.

Pretty soon I want to get out of Edna Moten’s house. She tells me the smell comes from her water, but it’s hard for me at this point to figure out where exactly it’s coming from. I just know I can breathe outside.

“We’re having big problems because the water’s bad,” said Moten. “We just been bombarded from all this time.”

Mystery Lesions

Susan Phillips / StateImpactPA

Dr. Amy Pare at her practice in suburban Pittsburgh.

Doctor Pare first met Edna Moten six years ago. Moten came to her because she had skin lesions. They were hard and thick, and sometimes they looked like boils.

“We didn’t know what they were,” said Pare.

They were mostly on Moten’s face, and hands.

“We just removed them because they looked like cancers,” said Dr. Pare.  “They looked like squamous cell carcinomas, they look like lymphomas, but they’re not. You didn’t want to miss anything, you didn’t want to miss any cancers so you would call up a pathologist and you would ask them and then they would refer it on to somebody else.”

Doctor Pare sent biopsies to several pathologists. She got the same results.

“It’s not a lymphoma,” said Pare. It’s not a leukemia, it’s not skin cancer. It’s a local inflammatory response. An inflammation is your body’s response to an irritant. That’s all we can say.”

But what she found really puzzling was that it wasn’t just Edna Moten. A bunch of people in the area were showing up with similar symptoms, including Moten’s daughters and neighbors.

“It just didn’t make sense,” said Pare.  “Why would you have clusters of people with inflammatory lesions on their face? So then when you would ask them, do you work in the same plant, what do you have in common? It was that they live near gas drilling areas. But I can’t say there wouldn’t be people in other areas who have these same symptoms. What would cause these type of inflammatory lesions, what type of exposures would that be?”

What, if any, are the links to drilling?

So Doctor Pare wondered, is there a connection between these lesions and gas wells? But that proved to be a tough question to answer.

“I’m not an epidemiologist, I’m not a toxicologist,” said Pare.

Pare makes an important point.  She, along with most general practitioners, and pediatricians, are not trained to evaluate whether chemicals in the environment are making a person sick. So Dr. Pare tried to find people who were experts.

She reached out to doctors in other states. She tried to find studies on the health impacts of this process for extracting gas, called hydraulic fracturing.  But few such studies exist, yet.

There hasn’t been much money for this type of research. Public health advocates in Pennsylvania had pushed for funds to do a health survey in heavily drilled areas, like Washington County. But that money was taken out of the new oil and gas law, known as Act 13, before it was passed by the legislature in February.

Susan Phillips / StateImpactPA

Edna Moten's daughters say they too developed lesions.

Pare reached out to a nurse in Washington County who was looking for similar answers. She suggested Doctor Pare take urine samples.

The results just brought up more questions.

They showed things like methane, hippuric acid, and phenol in the urine.

“So for one of the patients we tested his phenol level is 34,” said Pare. “I would not expect to see phenol in someone’s urine, but once again I’m not a toxicologist and this is something that I would say ok, I need an expert now to be able to help this person.”

So Doctor Pare called up the poison control center in Pittsburgh, the public health department and the state Department of Environmental Protection. She called the Environmental Protection Agency, and they referred her to the Centers for Disease Control and Prevention. None of these calls helped her solve the mystery.

Her conversations with experts at the Pittsburgh Poison Control Center and the CDC told her it would be very difficult to make a link between the results of the urine test and the skin lesions. In fact, it may not have even been the right test to do based on Moten’s water samples. And, it really requires good detective work on a doctor’s part. Pare would have to do an extensive health history and document what kinds of chemicals her patients may have been exposed to, including diet, and medications. But she and her patients are not even sure what exactly they were exposed to, if anything. Dr. Pare just knows what ended up in the urine.

“Those things end up in their urine,” said Pare. “I don’t know how they get there, I don’t know whether they breathe them in, whether they drink them in.”

The Mystery Grows

It turns out phenol and hippuric acid could get in a person’s urine in several different ways.

Toxicologists say phenol can end up in urine after smoking lots of cigarettes, or eating lots of sausage, or even fried chicken. But it can also come from exposure to benzene, a drilling related chemical. The source of hippuric acid could be food preservatives, or something as common as tea or wine. Or, it could be toluene – another drilling related chemical. And for your average doctor, to not be able to help their patients, this situation is really frustrating.

“I’ll be honest, we’re definitely looking for help and assistance to try figure out why this is,” said Pare. “And quite frankly, if it’s not related to gas drilling we want to know what it is related to.”

Dr. Tony Pizon, who is an assistant professor at the University of Pittsburgh and an expert in toxicology, has fielded calls from others physicians on this issue.  He says it’s difficult even for someone with his background to link chemical exposures and sickness.

“Taking aspirin could give you high urinary phenol levels as well,” said Pizon. “So there’s other exposures that may or may not be related to Marcellus shale drilling too. It becomes exceedingly difficult.”

Scant Help for Local Doctors

Pizon says calls from local doctors with questions about Marcellus Shale related exposures have jumped significantly. He says he understands why doctors like Amy Pare are having a hard time solving the mystery.

“I think a lot of specialists know what toxins they deal with on a daily basis. But in general when it comes to chemicals, and pesticides, and those things associated with Marcellus Shale drilling, I think those are a big enigma to most physicians.”

Although Pizon says he knows of drilling related exposures, he thinks there have been only a few cases. And of those, he says most have been limited.

Still, Dr. Pare understands how tough it is for the residents of Rae.

“It makes you sick,” she said. “It gives you headaches, you feel sick. You feel like you want to throw up. And I feel sad for the people who are effected because they have no one to protect them. I think the medical community needs to get together to protect them, because quite frankly that’s our job.”

Doctor Pare isn’t giving up hope. She’s trying to organize training to help doctors like herself know what to do when patients in gas drilling areas come in with strange symptoms. She’s also collecting data for a new project to study health in drilling areas.


  • Charlie Murphy

    The medical community is not likely to be the first professional group to take on the wrath of corporate America.  The keyword for the gas drilling industry is “Supremacy”.  They are “above the law” and they have every intention of staying there.  We are second class citizens and, at this point in time, there is little hope that that will change.

    • April Pierson-Keating

       It’s all about profit. Money is the bottom line. We are all going to suffer for the greed of the rich and powerful corporations.

  • InpatientMed

    Could someone please explain to me what a plastic surgeon is doing making house calls and sending urine for phenols and hippuric acid? 

    • Matos

      Med, did you read the article?

      • InpatientMed

        Have you ever met a plastic surgeon? They don’t do UA’s or make house calls, for that matter. So could you please explain to me why she is checking for phenol or hippuric acid.

        • Shratter

          Again, Impatient, this article states that Dr. Pare had treated others in this community with the same unusual symptoms and as any reliable physician would do, attempted to eliminate the usual causes. Once that is done, questions needed to be asked about possible exposure to toxins,  infection risks, etc. She just continued to investigate as she already had opinions from several pathologists who could not identify what these lesions were. Would you not want your doctor to make that effort for you?

          • InpatientMed

            Ever hear of a dermatologist? 

          • Steve Horn

            Med – get a clue.

          • Shratter

             Wow IMed. You either have a lot of misconceptions about physicians or you just don’t like them. You’re trying hard to discredit the care  this doc. is attempting to give her patients. She is able to see patients other than for aesthetic surgeries.

        • Maureen Dugan Hamilton

          She’s a doctor – isn’t that enough? She is holistically treating and investigating her patient’s malaise.

          • Iris Marie Bloom

            Fascinating to see how one “troll,” the InpatientMed commenter attacking, attacking, attacking a responsible health professional, wound up diverting people’s comments from the outpouring of compassion to having to “defend” and explain to Inpatient what a responsible health professional actually does. The reality is that the residents of Rae desperately need help; they’ve needed help all this time; and some of us are fundraising to get them safe clean water. We can’t provide safe clean air, unfortunately. But we are doing more than PA DEP or PA DOH to actually try to prevent further skin lesions, nausea, and other symptoms from which this community is continuing to suffer; there have been several deaths. Congratulations to StateImpact for covering this important issue, and we think Dr. Amy Pare is a role model — competence, compassion, and courage — for the health professionals throughout PA who find shalefield residents coming to them with symptoms which are hard to explain. Listen, take careful histories, ask MORE questions, don’t take anything for granted, and ask about gas drilling — as well as other potential environmental impacts — timelines, including infrastructure. Often we won’t know until decades later what really happened; sometimes we won’t know at all. But health professionals who ask the right questions and follow up and refuse to be intimidated by an extremely aggressive, intentionally intimidating industry, have the best chance of treating patients successfully AND protecting public health!

    • Alizabeth Szilagyi

      Let’s say I have a child born with a cleft lip … who fixes that?  Let’s say I get in a car accident and have burn injuries that need repair … who fixes that?  

      This notion that plastic surgeons only serve the wealthy and vain “1%” is absurd. She is “reconstructing” visible skin and tissue damage caused by, what may be, chemical leaks from fracking. That isn’t  hard to understand, nor is her sincerity frustrating.  Especially since it states this in paragraph 3: “She’s a plas­tic and recon­struc­tive sur­geon”  


  • Shratter

    Because a doctor is a doctor is a doctor. The patient who sought a plastic surgeon to remove the skin lesions may have been referred by their primary care MD. You are to Impatient to understand that the concerns of this doctor make sense.

    • InpatientMed

      OK fine. A doctor is a doctor is a doctor. But what is the agenda of a doctor who doesn’t check urine for anything and doesn’t make house calls ever. Lets be clear, Dr. Pare is a plastic surgeon. She caters to those in our midst most obsessed with appearance. She specializes in face lifts, breast augmentation, tummy tucks and liposuction. She most assuredly does not sit at the bedside of the dying or provide comfort to the sick. She is making money, lots of it, off of the vanity of the 1%. So what is her agenda and who is counseling her?

  • suzen

    my guess is that doctor is not under a gag order by the gas companies * 

  • Maggie Henry

    Dr. Pare might not be under gag orders but you can bet your life than anyone who works for a university who accepts money from the gas industry is! Have you read or listened to
    It illuminates the matter perfectly!

  • mjcreech

    Here’s another bad-health-related-to-gas-drilling example from PA. I expect there are many other examples–it’s just beginning.  In this testimony–there is also a U-Tube–the guy of the couple is now dead from intestinal cancer. Their blood tested for barium and arsenic and other fracking chemicals also found in their water supply.  Judy’s testimony before Carl died.

  • Trenalg

    This caring dermatologist’s actual care and concern for her patients’ well-being is very refreshing.  She’s going out of her way, makiing house calls, investigating, networking with people in other professions, trying to enlist the help of other physicians, because she actually cares about her patients and actually wants to help provide solutions to her patients’ sufferingss!  WOW!  We USED TO believe that this was the norm for doctors, but not anymore.  Now, this caring attitude among doctors seems highly unusual, even, friom my experience, rare.

  • wildoo

    Why does this whole piece/effort scream out 2 me “ulterior motive” ?
    If not ulterior motive, then preconceived theorems.
    Of course I’m jaded. Who’s not. . .but you have ever-so-deep pockets of
    Big Oil, and you have ever-so-convenient and reviled fracking process.

  • Sbc Prc

    Wouldn’t they have to look for these symptoms in areas were they are not gas drilling? that’s the first thing I would do. If you can establish that these symptoms occur at a significantly higher rate in areas of drilling, then you can go from there. Basic high school science.

  • Kathy Walker

    I lost a brother to cancer, he lived in Rae, his water was contaminated from these wells, drinking water was bad, I belive this is what caused his cancer, was never sick until these wells were done around his place,

  • BinFranklin

    These signs and symptoms, particularly the non-cancerous skin lesions, remind me of hexavalent chromium poisoning.

  • Sun-E-Day

    Am I wrong? The word “effected” should have been “affected”.

  • Visitor from Beaver County

    I live in Beaver County, but happened to be in Avella last weekend.  I took the short cut from Atlasburg, past Raccoon Valley Sportsmen’s Club Lake.  I knew drilling was going on and I also saw truck after truck associated with that drilling.  I would never have believed the smell was as horrible as it was.  (I had heard the smell was bad!)  Nothing prepared me for that gassy/rotten egg smell that stayed in my car for hours and hours.  Let’s think about this.  If the air smells bad and the water smells and is bad, wouldn’t anyone pretty much guess there is a big health problem associated with the “fracking”.   My thoughts and prayers go out to each and everyone in this little town of Rhea!

    • Tanabb

      I’m with u all the way on the happenings in Rae

  • Slamm65us

    There was a train derailment about 100 feet from Mrs Motens back yard about 3 or 4 years ago, it was tanker cars carrying styrene based chemical , one car leaked a very small amount . Washington County Haz Mat  and local fire dept was there , I was with the local fire dept , the smell of the styrene was awful . Maybe a combo of spills and drilling can be causing problems.

  • S. Thomas Bond

    Nothing else brings out the psychopath in some people like the shale drilling industry!

    • Ginny Ann Tonick

       That’s because the psychopaths control the industry.

  • Wreading

    This is a great story! We all need to get more information to pinpoint what is causing this problem before it spreeds to larger towns and cities in PA. 

  • John

    If ANY company is pumping a soup of chemicals into the environment, then exact documentation of every chemical used must be publicly available to everyone. If we know the signatures of each chemical, then we would know if the source was Hydraulic Fracturing. We know for a fact that Humans are responsible for Climate Change because we are able to trace the source of atomspheric Carbon back to fossil fuels in the same way. That corporations are allowed to withhold this information is an obvious sign of extreme political corruption, putting millions of people at risk.

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