In related moves, some members of Congress are accusing agencies responsible for worker health of not doing their jobs. And public health professionals nationwide are being told how to identify and report the disease.
The National Institute of Occupational Safety and Health has assigned additional teams of physicians, toxicologists and industrial hygienists to work with the industry and with state and local health departments that have identified workers who might have contracted the disease, bronchiolitis obliterans, which can destroy lungs.
Last week, more than 60 physicians, toxicologists and other medical specialists from a dozen states, Baltimore and NIOSH took part in a conference call to discuss ways they can track and assess the health of workers exposed to the flavoring chemicals.
The call, organized by the Council of State and Territorial Epidemiologists and the California health department, was initiated "because we fear that this disease will be found in workplaces across the country," said Dr. Robert Harrison, chief of California's division of occupational surveillance and president-elect of the national council.
In Washington, investigators from the Democratic side of the House Committee on Education and the Workforce are collecting information on diacetyl, the flavoring industry and the way NIOSH and other agencies are handling worker illness.
"Workers are dying preventable deaths from these flavorings," said Rep. George Miller, a California Democrat and ranking member of the committee. "This is inexcusable, and it must stop."
The actions follow an investigation by The Sun into the risks of working with diacetyl and the butter flavoring that contains it.
Inhalation toxicThousands of workers make or use flavorings containing diacetyl in snack foods, frozen foods, pastries and other products. Consumers who prepare or eat the products are not endangered, but inhalation of heated diacetyl vapors has been shown to be toxic.
NIOSH scientists and other experts initially identified the problem in popcorn plants that use butter flavoring with diacetyl. In April, the newspaper reported cases of the lung disease in other sectors of the food industry.
The newspaper article also described the way some federal and state agencies have allowed the flavoring industry to police itself. In California, the state occupational safety agency, Cal/OSHA, has delegated health examinations of workers in flavoring plants to an industry-paid doctor.
Scientists at NIOSH's respiratory laboratory in Morgantown, W.Va., who have been leading the effort to document injuries related to flavoring agents, were invited to join the California investigation, then excluded from it.
"For Cal/OSHA to take the posture that it will wait until the industry consultant assesses risk before it acts is an abdication of its responsibility," said Jeff Ruch, executive director of Public Employees for Environmental Responsibility, a national group that defends the ethical concerns of government workers.
"Our laws protecting worker health work only when they are implemented."
The Occupational Safety and Health Administration has issued no specific guidance to the flavoring industry, even though its scientists have urged it to do so.
U.S. Rep. Hilda L. Solis, a Democrat who represents the Los Angeles district where two stricken flavoring plant workers live, is demanding that OSHA do more.
"I urge an immediate investigation of these complaints and risks," she said. She also demanded that agencies use their authority to protect workers.
"These illnesses and deaths are preventable. Further inaction is inexcusable," Solis said.
Interviews with California occupational medicine personnel and e-mail obtained from NIOSH under the Freedom of Information Act indicate that state officials told federal experts they were barred from the investigation because the flavoring industry trade association wanted it that way. The Flavor and Extract Manufacturing Association denied that.
"NIOSH was offered the opportunity by Cal/OSHA to participate in the Cal/OSHA investigation of flavor manufacturing in California, but NIOSH declined to participate, citing a lack of resources," John Hallagan, the association's lawyer, said in an e-mail sent to The Sun on May 18.
NIOSH disputes that.
"We never declined to do anything," said Dr. Richard Kanwal, a senior medical officer with the NIOSH team in Morgantown, which has conducted six years of research on popcorn plant workers whose lungs were damaged by diacetyl.
"We did point out that we didn't have the resources to do an investigation of multiple plants by ourselves and that therefore we would want to partner with Cal/OSHA and the state health department. This is pretty much what we were working toward until [the Flavor and Extract Manufacturing Association] insisted on having its consultants involved."
The California health department says it has not been permitted to have its occupational medicine specialists enter the plants and interview and examine workers. Nor, it says, has it received the specific results of the examinations of workers by a physician hired by the plants.
Although NIOSH spokesman Fred Blosser said the agency is "greatly expanding" its investigation, the Morgantown team appears to have lost its primary role.
Half a dozen physicians across the country told The Sun they have been referred to NIOSH's Cincinnati laboratory to obtain and offer information on new cases because the Morgantown researchers were no longer leading the flavoring investigation.
The trade association had complained to NIOSH about statements Morgantown researchers made to the newspaper. And in early May, Hallagan met with Dr. David Weissman, head of the Morgantown team.
Blosser said Weissman "did not apologize for statements by NIOSH personnel. He expressed regrets if statements that had appeared in the press had damaged FEMA's perception that NIOSH could work fairly and objectively."
"I know of no retaliation," Blosser said, adding that the Morgantown scientists were not out of the picture.
"NIOSH has need of those scientists' medical assessment expertise and their firsthand experience with flavoring studies as a part of the expanded research and surveillance program now being pursued by an institute-wide team," he said.
Warnings in SpanishBlosser said his agency is "intensely pursuing all aspects of the flavoring issue." Concerned because two victims interviewed by The Sun had Latino names, "the agency has translated its warning on diacetyl into Spanish and posted it on the NIOSH Web site," he said.
In their efforts to learn more about the flavoring industry and the hazards of the chemicals it uses, NIOSH, Harrison and congressional investigators have obtained information from an unexpected source.
Dr. David Egilman, a specialist in occupational and internal medicine, has testified as an expert witness at the request of plaintiffs in several of the suits by popcorn workers injured by flavoring agents. In the course of that work, Egilman said, he reviewed hundreds of documents that the companies and the trade group called confidential.
The government investigators requested the documents in April and May.
The large flavoring companies Givaudan and International Flavoring and Fragrances said Egilman could turn over documents that did not violate worker privacy or reveal trade secrets. The trade association refused, he said.
Hallagan did not respond to requests for comment.
"It would be unethical not to provide information to government agencies that they need to save lives," Egilman said. "There is too much secrecy shrouding the issue of who knew diacetyl was dangerous and when."
This article contained an incorrect reference to the Federal Emergency Management Agency when it was published in the print edition. The Sun regrets the error.