Monthly Archives: April 2014


In total disagreement with Public Health England’s report, on the unconventional extraction of gas in the UK, which had mistaken best practice for actual practice in regards to safety assessments, a draft report from PSE Healthy Energy (below) shows that more research and safety checks need to be carried out for both environmental and health impacts, and they say PHE were wrong to characterise the threat to public health as low.

Back in January we contacted the BMA to alert them to the fact that Public Health England’s report into the health effects of the industry was totally lacking in its failure to regard the latest research around Endocrine Disrupting Chemicals in fracking fluid. PHE’s excuse for not doing so was that there was no evidence chemicals used in the USA will be used in the UK.  We noted with extreme concern that the bias in that statement was entirely against their ethical responsibility to societal health as a whole and were concerned that overlooking the latest scientific studies would mean no proper assessment on impacts on human health would be made, facilitating accountability when serious and widespread damage is inevitably caused to local populations. We are very pleased that the below draft report finally acknowledges that fracking places a significant risk to the population and that the initial report was lacking in assessing this fairly and accurately.

Public Health England’s draft report on shale gas extraction

BMJ 2014; 348 doi: (Published 17 April 2014)
Cite this as: BMJ 2014;348:g2728

Adam Law, clinical assistant professor of medicine 1,
Jake Hays, program director2,
Seth B Shonkoff, executive director 3,
Madelon L Finkel, professor of clinical public health1

Author Affiliations

Mistaking best practices for actual practices

Global interest in developing unconventional natural gas reserves continues to increase, despite the paucity of empirical evidence on risks to the environment and human health. The operations required to produce natural gas from hydrocarbon reservoirs such as shale are spatially intense and sometimes occur close to human populations. Although research has been conducted to understand the potential impacts of gas development on public health, for the most part these efforts fall short. In addition, efforts to summarise the existing public health science tend to focus on regulations and engineering solutions, rather than on health outcome data and pathways of exposure. A focus on mostly hypothetical regulatory and engineering solutions may mistake best practices for actual practices, and supplants the empirical with the theoretical.

To the extent that they are technically and economically feasible, risk reduction technologies that mitigate adverse health outcomes should be deployed. However, reviewing the public health aspects of the development of the shale gas industry requires more than merely gesturing to technological improvements that lack empirical data on their effectiveness in the real world. The optimism that fail-safe engineering solutions can ensure safe shale gas development may result more from a triumph of marketing than a demonstration of experience.

Public Health England’s draft report thoroughly assesses the peer reviewed scientific literature on the public health implications of extracting shale gas.1 It accurately presents the problems of air and water quality,2 3 4 5 and it correctly recognises that many uncertainties surround the public health implications of extracting shale gas. The review was rigorous in its presentation of the evidence, but there are problems with its conclusions.

The review appropriately acknowledges differences in geology and regulation between the United States and the United Kingdom. Yet, in a leap of faith unsubstantiated by scientific evidence, its authors suggest that many of the environmental and public health problems experienced in the US would probably not apply to the UK. Unfortunately, the conclusion that shale gas operations present a low risk to public health is not substantiated by the literature. The correct conclusion that Public Health England should have drawn is that the public health impacts remain undetermined and that more environmental and public health studies are needed.

Furthermore, the report incorrectly assumes that many of the reported problems experienced in the US are the result of a poor regulatory environment. This position ignores many of the inherent risks of the industry that no amount of regulation can sufficiently remedy, such as well casing, cement failures, and accidental spillage of waste water.6 There is no reason to believe that these problems would be different in the UK, and the report provides little evidence to the contrary, despite repeated assertions that regulations will ensure the safe development of shale gas extraction.

The report also has other shortfalls. More attention should have been paid to drilling in areas that are densely populated. In the US, much of the extraction of shale gas occurs in rural sparsely populated areas. This would not be the case in the UK. Studies suggest that health risks are modified by geographical distance of residences from active shale gas extraction.7 Recent evidence suggests a higher prevalence of some adverse birth outcomes for those living in closer proximity.8

Public health is an evidence based discipline, and findings from well designed studies should form the backbone of public policy. There is also a need for an assessment of the public health infrastructure and the ability of healthcare professionals to respond to the risks presented by the development of the shale gas industry.9 Rigorous, quantitative epidemiological research is needed to assess the risks to public health, and data are just starting to emerge.10 As investigations of shale gas extraction in the US have continually suggested, assurances of safety are no proxy for adequate protection.


Cite this as: BMJ 2014;348:g2728


Competing interests: We have read and understood the BMJ Group policy on declaration of interests and declare AL, JH, and SBS all have roles within Physicians Scientists & Engineers for Healthy Energy (PSE). This organisation’s mission is “to provide a multi-disciplinary approach to identifying reasonable, healthy, and sustainable energy options for everyone.” It works to “help empower citizens and policymakers by organizing and supplying objective, evidence-based information.” PSE did not receive any funding for the preparation of this manuscript. MLF has no competing financial interests to declare.

Provenance and peer review: Not commissioned; externally peer reviewed.

01.↵Kibble A, Cabianca T, Daraktchieva Z, Gooding T, Smithard J, Kowalczyk G, et al. Review of the potential public health impacts of exposures to chemical and radioactive pollutants as a result of shale gas extraction. Public Health England, 2013.
02.↵Colborn T, Schultz K, Herrick L, Kwiatkowski C. An exploratory study of air quality near natural gas operations. Hum Ecol Risk Assess 2012;20:86-105.SFX@King’s
03.↵Pétron G, Frost G, Miller BR, Hirsch AI, Montzka SA, Karion A, et al. Hydrocarbon emissions characterization in the Colorado front range: a pilot study. J Geophys Res Atmos2012;117:DO4304.SFX@King’sCrossRef
04.↵Osborn SG, Vengosh A, Warner NR, Jackson RB. Methane contamination of drinking water accompanying gas-well drilling and hydraulic fracturing. Proc Natl Acad Sci U S A2011;108:8172-6.SFX@King’sAbstract/FREE Full Text
05.↵Warner NR, Jackson RB, Darrah TH, Osborn SG, Down A, Zhao K, et al. Geochemical evidence for possible natural migration of Marcellus formation brine to shallow aquifers in Pennsylvania. Proc Natl Acad Sci U S A2012;109:11961-6.SFX@King’sAbstract/FREE Full Text
06.↵Rozell DJ, Reaven SJ. Water pollution risk associated with natural gas extraction from the Marcellus shale. Risk Anal2012;32:1382-93.SFX@King’sCrossRefMedlineWeb of Science
07.↵McKenzie LM, Witter RZ, Newman LS, Adgate JL. Human health risk assessment of air emissions from development of unconventional natural gas resources. Sci Total Environ2012;424:79-87.SFX@King’sCrossRefMedlineWeb of Science
08.↵McKenzie LM, Ruixin G, Witter RZ, Savitz DA, Newman LS, Adgate JL. Birth outcomes and maternal residential proximity to natural gas development in rural Colorado. Environ Health Perspect 2014.
09.↵Goldstein BD, Kriesky J, Pavliakova B. Missing from the table: role of the environmental public health community in governmental advisory commissions related to Marcellus shale drilling. Environ Health Perspect2012;120:483-6.SFX@King’sCrossRefMedlineWeb of Science
10.↵Kovats S, Depledge M, Haines A, Fleming LE, Wilkinson P, Shonkoff SB, et al. The health implication of fracking. Lancet2014;383:757-8.SFX@King’sCrossRefMedlineWeb of Science

Public Health England’s draft report on shale gas extraction | BMJ
NotesCite this as: BMJ 2014;348:g2728