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May 2000

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Did Pesticides Cause Giuliani's Cancer?

Robert Lederman (ARTISTpres@aol.com)

During a Town Hall meeting in College Point Queens on 4/27/2000 Mayor Giuliani responded to a question from activist Joyce Shepard concerning the U.S. Environmental Protection Agency's reclassification of Malathion as a human carcinogen. The Mayor, who had just hours earlier publicly announced that he was diagnosed with prostate cancer, vehemently denied that Malathion was a carcinogen. He stated that there were no cases of anyone becoming ill or getting a disease from the controversial chemical he had ordered massively sprayed on the City by helicopters in the Fall of 1999.

Perhaps Mayor Giuliani, who claimed that he was directly sprayed with Malathion numerous times from helicopters last Fall, is in denial. Perhaps he is characteristically refusing to admit that he is wrong. Either way, the facts are very much at odds with the Mayor's statement.

The following brief extract from a report in the Journal of Occupational Medicine specifically addresses a connection between pesticides like Malathion and prostate cancer:

Occup Environ Med 1999 Jan;56(1):14-21

Mortality in a cohort of licensed pesticide applicators in Florida.

Fleming LE, Bean JA, Rudolph M, Hamilton K

Department of Epidemiology and Public Health

University of Miami School of Medicine, FL 33101, USA.

lfleming@mednet.med.miami.edu

OBJECTIVES: Although the primary hazard to humans associated with pesticide exposure is acute poisoning, there has been considerable concern surrounding the possibility of cancer and other chronic health effects in humans. Given the huge volume of pesticides now used throughout the world, as well as environmental and food residue contamination leading to chronic low level exposure, the study of possible chronic human health effects is important...Among male applicators, prostate cancer mortality (SMR 2.38 (95% confidence interval (95% CI) 1.83 to 3.04) was significantly increased.

CONCLUSIONS:

Consistent with previous publications on farmers but at odds with current theories about the protective effects of vitamin D, prostate cancer was increased in these pesticide applicators.

 

After his insistent denial that Malathion causes cancer Joyce Shepard begged the Mayor to personally research the chemicals he has said will be used this year instead of Malathion-all of which are also proven carcinogens. The Mayor brushed off her request and handed the microphone to Dr. Neal Cohen, his Commissioner of Health. Cohen, a psychiatrist who is linked to the Giuliani administration by marriage and who has been a vociferous defender of the spraying program, is considered by many to be a puppet totally unqualified to hold his past as Commissioner of Public Health.

Later in the evening a man got up from the audience and told the Mayor that last year he had been eating his dinner by an open window and had been directly sprayed. The visibly ill man complained there was no advance warning before the helicopters arrived and reported immediately vomiting, being knocked off his feet and suffering significant health consequences from the direct exposure. The Mayor's unsympathetic response was that in a large operation like the spraying, accidents will happen.

Accidents will indeed happen but can one call knowingly exposing millions to a known carcinogen, failing to give adequate notice, ignoring virtually every safety recommendation on the products' label [see links to labels below] and deliberately and repeatedly lying about the known risks of exposure-to be accidents?

The Mayor and Dr. Cohen announced that this year they will spray Resmethrin, Sumethrin and Permethrin-all of which were also massively sprayed last year from trucks-across much of the City if there are reports of infected mosquitoes. The quotes following my comments are a minute sample of the huge amount of literature readily available on these chemicals to anyone with a computer or the time to visit a public library.

The question is, will the Giuliani administrationís insistence on unnecessarily exposing us to toxic chemicals be an accident again this year? Considering that the City has refused to release the name of a single so-called victim of West Nile-like Virus [WNV], is it unreasonable to question whether this normally non-fatal illness is even present in New York or that if it is, that the certain risk of exposure to these chemicals is worth taking in light of the fact that according to the Department of Healthís and the CDCís own press releases it is:

a. extremely difficult to become infected with WNV and,

b. that the vast majority of those infected have few if any symptoms and fully recover without any treatment.

Considering that the media has been fully and repeatedly briefed on the non-fatal nature of West Nile Virus by the Mayor, the CDC, the EPA and by the activists in NYC fighting further exposure to these chemicals, is it unfair to ask why they persist in hyping this non-existent epidemic as an urgent public health emergency, as a dread killer disease and as a plague? Would it surprise you to learn that pharmaceutical companies that have untested WNV vaccines stockpiled and ready to be marketed, chemical companies that are among the largest sponsors of the commercial media and bio-warfare labs whose funding is based on creating a sense of panic among the public are the beneficiaries of this manufactured epidemic?

[See: "Encephalitis for Population Control and Profit" and "Why is the Media Lying About The West Nile Virus Epidemic?" by Robert Lederman]

While the Mayor, with the media's dedicated assistance, is reaping a sudden windfall of good will based solely on his being diagnosed with a disease we can only hope he will take a moment to consider that we the people of New York City have a legal and moral right to not be poisoned by him, by Dr. Cohen or by the corporate interests they are actually working for while pretending to represent our interests.

From:

Newsday

4/14/2000

City Nixes Malathion Spraying

Dr. Neal Cohen testified yesterday that if aerial or truck spraying is needed at all this year, the products will be Scourge, known chemically as resmethrin and used last year; Anvil, which is sumethrin, and Agreo Permanone, or permethrin.

FROM:

PERMETHRIN

Permethrin, like all synthetic pyrethroids, is a neurotoxin. Symptoms include tremors, incoordination, elevated body temperature, increased aggressive behavior, and disruption of learning. Laboratory tests suggest that permethrin is more acutely toxic to children than to adults.

The U.S. Environmental Protection Agency has classified permethrin as a carcinogen because it causes lung tumors in female mice and liver tumors in mice of both sexes. Permethrin inhibits the activity of the immune system in laboratory tests, and also binds to the receptors for a male sex hormone. It causes chromosome aberrations in human and hamster cells.

Effects on Reproduction

Permethrin affects both male and female reproductive systems. It binds to receptors for androgen, a male sex hormone, in skin cells from human males, causing researchers to ìadvise protection from any form of contact or ingestion of the pyrethroids. Permethrin also binds to a different receptor, called the peripheral benzodiazepine receptor, that stimulates production of the male sex hormone testosterone. In addition, permethrin caused reduced testes weights in a long-term feeding study of mice. In females, permethrin exposure has caused embryo loss in pregnant rabbits and in pregnant rats.

Effects on the Immune System

Experiments with laboratory animals indicate that the immune system (used by living things to defend themselves from disease) ìappears to be a sensitive target for permethrin activity. Ingestion of permethrin reduces the ability of immune system. cells called T-lymphocytes to recognize and respond to foreign proteins. Doses equivalent to 1/100 of the LD50 , inhibited T-lymphocytes over 40 percent. Permethrin ingestion also reduced the activity of a second type of immune system cell, natural killer cells, by about 40 percent.20(SeeÝFigure 2.) In tests using mouse cell cultures, permethrin had similar effects on the immune system, inhibition of two kinds of lymphocytes.21 Researchers concluded that ìthe immune system is exquisitely sensitive at exposure levels that cause no overt toxicity.

Other Chronic Effects

The liver is a sensitive target for permethrin effects. When EPA summarized 17 medium- and long-term laboratory studies that exposed rats, mice, and dogs to permethrin, effects on the liver were noted at the lowest effect levelî in all of them. Other chronic effects in laboratory tests include enlarged adrenal glands at all doses tested in a rabbit feeding study, and increased kidney weights at all doses tested in a rat feeding study.

Synergy

Synergy occurs between two or more chemicals when their combined exposure causes more adverse effects than the sum of their individual effects. A possible cause of the health problems reported by 30,000 veterans who served in the Persian Gulf War is exposure to a combination of chemicals, including permethrin. The combination of permethrin, the anti-nerve gas drug pyridostigmine bromide, and the insect repellent DEET has been tested in laboratory animals. Neurotoxic symptoms, including decreased activity, diarrhea, shortness of breath, tremors, inability to walk, and damage to nerves, were observed in hens exposed to all three chemicals, but not in hens exposed to permethrin alone. Permethrin with just pyridostigmine bromide or just DEET also caused tremors and inability to walk, but symptoms were not as severe. Other pesticides interact synergistically with permethrin with in other species. Permethrin and the herbicide atrazine synergistically induce growth of the soil fungus Pythium ultimum, and permethrin and the insecticide amitraz are synergistically toxic to the bollworm.

Based on tests with laboratory animals, it appears children may be more sensitive to permethrin than adults. Permethrin is almost 5 times more acutely toxic to 8-day-old rats than it is to adult rats. (See Figure 4.)

Since sulfates are involved in one of the major pathways by which permethrin is broken down in humans, individuals with defects in sulfate-related enzymes may be unable to easily break down permethrin, leading to increased susceptibility to motor neuron disease. Individuals with genetic variants of the enzyme pseudocholinesterase that have reduced activity are at higher risk of adverse effects from exposure to certain chemicals, including the permethrin combination implicated in symptoms seen in Gulf War veterans.

FROM:

Resmethrin

The pesticide containing resmethrin being used in NY City is called Scourge (TM). It is 18% resmethrin, 54% piperonyl butoxide and 28% inert ingredients. Piperonyl butoxide makes the pesticide more effective by preventing insects from detoxifying resmethrin....

Piperonyl butoxide has been classified by the Environmental Protection Agency as a possible human carcinogen. Manufacturers are not required to disclose the inert ingredients, although they may be toxic also.

{Read this carefully for a clue as to why we are not being protected by the EPA]

From:

Daily News

2/8/2000

Feds Probe Pesticide Cancer Link

The federal government is investigating whether malathion - the pesticide that was sprayed over the New York area to combat last summer's outbreak of West Nile fever - may cause cancer. The investigation was revealed in a letter last week from a U.S. Department of Agriculture official to a Washington, D.C.-area environmental scientist.

"The EPA [Environmental Protection Agency] is considering changing the registration status of malathion because of studies that suggest it could be a low-level human carcinogen," wrote Harold Smith, a senior project leader in policy and program development at the USDA. The letter, a copy of which was obtained by the Daily News, was sent to Dr. Robert Simon, a toxicologist who has been a steadfast critic of New York's massive pesticide spraying. Smith was responding to Simon's questions about malathion's impact on the environment. Mary Helen Cervantes, a spokeswoman for the EPA's New York regional office, confirmed yesterday that the agency is reassessing malathion's health effects. But she insisted malathion was only one of many pesticides under review. ìWeíre looking at some of the older pesticides to make sure that they meet the standards of the latest science," she said. New federal laws, Cervantes said, require the agency to "look at pesticides based on the effects on children - the most vulnerable population."...During the past few months, in testimony before the City Council and other government groups, Simon and other environmental activists have insisted that malathion is not as safe as federal officials have claimed. Simon has pointed to studies in scientific journals like The Lancet and the Canadian Medical Association Journal that have reported leukemia and bone-marrow disorders in children and significantly higher leukemia rates among farmers exposed to malathion. One 1996 study in the journal Cancer Research reported genetic damage in white blood cells exposed to malathion. Some people might ask why it has taken so long for the EPA to get around to reviewing its approval of malathion and other organophosphate pesticides. Well, part of the reason could be the cushy revolving door that has developed between the EPA and the pesticide industry. According to a recent study by the Environmental Working Group in Washington, four of the six assistant administrators for pesticides and toxic substances at the EPA since the office was founded in 1977 went to work or lobbied for the pesticide and agribusiness industry when they left the agency. Steven Jellinek, the first head of the office under President Jimmy Carter, is now chairman of Jellinek, Schwartz & Connolly Inc., a consulting firm that represents some of the biggest pesticide companies in the world, including Monsanto, Dow and Cheminova. Cheminova, by the way, is the firm that produces the malathion that was sprayed on New York City. Jellinek's firm boasts a slew of former EPA officials in its ranks, including Dan Barolo, who until 1997 was the Clinton administration's director of the Office of Pesticide Programs. So it should surprise no one that the EPA has taken its sweet time about reviewing studies that question the "safety" of pesticides..."No pesticide is 100% safe," Cervantes said. "Those who are applying it and the public have to exercise caution and care and follow the strict labeling requirements." The same cannot be said of our own mayor, who amid the West Nile virus crisis, kept repeating over and over that aerial spraying of malathion was perfectly safe.

Original Publication Date:

02/08/2000

From:

NY Times

4/14/2000

Mosquito Program Favors Prevention Over Pesticide Use

New York City has decided not to spray malathion, the pesticide it used against mosquitoes last year, in its campaign to prevent another outbreak of West Nile virus, and to use helicopter spraying only as a last resort....The city's health commissioner, Dr. Neal L. Cohen, said the city had decided not to use malathion because it was under a safety review by the federal Environmental Protection Agency. "Our confidence needs to be deferred until questions raised by the review are resolved," he said...At that time, Mayor Rudolph W. Giuliani scoffed at the idea that malathion was harmful and vowed to keep spraying as long as it was necessary...At a news conference yesterday, neither Mayor Giuliani nor Dr. Cohen mentioned the city's decision to abandon malathion. The plan to use other insecticides was on the fifth page of a five-page news release on the city's extensive plan to ward off another West Nile outbreak...Dr. Cohen was jeered by several environmental advocates at the hearing when he announced that the city would, if needed, use other chemicals for spraying: Scourge, Anvil and Agrevo Permanone, which Ms. Haight's group finds far less objectionable than malathion.

[NOTE: Was the EPA reclassification unknown to Mayor Giuliani and Dr. Cohen before they began spraying Malathion? The spraying began in the Fall of 1999. Note the date of this article excerpt]

FROM:

Monday February 2, 1998

Tampa Tribune

Tampa, Florida.

Urban application of malathion questionable

"Malathion is part of a chemical class that has been identified by the agency as one of the riskiest classes of chemicals," said Steve Johnson, an EPA pesticide administrator.

FROM:

Newsday

4/14/2000

Report: EPA failing to protect children farmworkers from pesticides

WASHINGTON (AP) -- Children working on farms are not adequately protected by the federal government from exposure to potentially dangerous pesticides, according to a report by the nonpartisan investigative arm of Congress. The General Accounting Office report concluded that children in farm fields "are especially vulnerable to the adverse effects of pesticides and are not adequately protected from pesticide exposure." The report released Thursday said the Environmental Protection Agency's Worker Protection Standard is not enforced consistently and treats children as adults. For instance, when the EPA measures the amount of time that should elapse before workers are allowed back into the fields after pesticides are sprayed, it uses a body weight of 154 pounds - well over the weight of a small child, the report found...''The Department of Labor has found children as young as six working in agriculture. We know that children far younger than that are accompanying their parents into the field,'' she said. ''The health of hundreds of thousands of children is at great risk.''...The GAO report said children under age 12 are at increased risk because their internal organs are maturing, they fail to wear clothing that protects them from exposure and they are involved in more contact with plants and soil.

FROM:

*Pesticide Research Updates, February 2000*

Pesticide Action Network North America (PANNA)

*Green Blood--Red Tears, 1999*

Joe Terrence Gray

Documentary film examines the relationship between depression and suicide among U.S. farmers. Presents studies that suggests use of organophosphate-based pesticides could increase the risk of suicide.

*Suicide and depression resulting from exposure to pesticides among tobacco farmers in Paran·, Brazil: A pilot study, 2000*

Natascha M. Smits

Discusses depression and suicide rate among tobacco farmers in Brazil. Reviews epidemiological studies on chronic exposure to pesticides and suicide, on chronic pesticide exposure and depression and on acute exposure and depression. Includes chapters on tobacco cultivation in Brazil, suicide and depression, toxicological mechanisms and more. 68 pp. Contact Environmental and Occuaptional Health, Ritzema Bosweg 32-A, P.O. Box 238, 6700 AE Wageningen, the Netherlands

FROM:

No Malathion

Health Chief: City Not Spraying Until EPA Gives Okay

By Timothy Williams

The Associated Press

N E W Y O R K, April 14

The city will not spray malathion to kill mosquitoes infected with the West Nile virus until the Environmental Protection Agency completes its review of the pesticide sometime late this summer, the cityís health director said Thursday...During several rounds of aerial citywide spraying, Giuliani, Cohen and other officials repeatedly told people that the pesticide was safe...

Linked to Rashes, Asthma

Many residents, however, were doused with the chemical during times that spraying had not been scheduled. Dozens of people complained that the malathion caused rashes and flare-ups of asthma and other respiratory illnesses. As recently as January, Cohen refused to rule out the possible use of malathion and in the health departmentís report released Thursday on its plan to prevent another outbreak of encephalitis this year, no mention is made of suspending the use of the pesticide...Instead of malathion, the health department plans to use other pesticides, including resmethrin, sumethrin and permethrin if spraying becomes necessary, Cohen said.

FROM:

Press Release

New York City Office of Public Affairs

From Giuliani

IMMEDIATE RELEASE:

Thursday, April 13, 2000

Contact:

Sunny Mindel / Mary Lasher

(212) 788-2958

Sandra Mullin, DOH (212) 788-5290

MAYOR GIULIANI ANNOUNCES COMPREHENSIVE WEST NILE VIRUS PREVENTION AND CONTROL PLAN

If spraying is needed to prevent or address illness in the human population, EPA and DEC-approved pyrethroid-based insecticides would be used, including Scourge (Resmethrin), Anvil (Sumethrin), and Agrevo Permanone (Permethrin). They would be sprayed primarily by truck, but if necessary, also from the air. The City's early warning systems will detect the spread of West Nile virus in birds and mosquitoes, and will help direct targeted and effective use of pesticides, if needed.

To see the Mayor's Comprehensive Plan with links to the pesticides, go to:

Mayor's Comprehensive Plan

 

FROM:

Poisoning Case May Lead to Test for Chemical Exposure.

4/25/2000

NEW YORK (Reuters Health) - A 7-year-old boy ended up with mild mental retardation after being exposed to chemicals in infancy, researchers report. A closer analysis revealed that the boy had antibodies -- immune system proteins -- in his blood that recognized proteins found in nerve cells, which may have been at least partly related to the neurological damage. The finding may help determine if other people with exposure to the chemicals, which are known as organophosphates and found in insecticides and industrial chemicals, are indeed experiencing problems because of the exposure. Some Gulf War veterans have similar neurological problems as the boy, and may have been exposed to organophosphorus compounds, according to Dr. Mohamed B. Abou-Donia, of Duke University Medical Center in Durham, North Carolina.

[NOTE:

Last year during the so-called mosquito epidemic, Mayor Giuliani personally distributed free bottles of DEET, an insect repellent, throughout the City. The Mayor didn't bother to tell the families of children who were slathering this toxic substance on their kids that the company no longer manufactures this concentration of DEET because of its known dangers. The thousands of bottles being generously given away would be illegal to manufacture or sell today. The giveaway was a corporate promotion, courtesy the Giuliani administration.]

FROM:

MMWR; October 06, 1989 / 38(39);678-680

Epidemiologic Notes and Reports Seizures Temporally

Associated with Use of DEET Insect Repellent -- New York and Connecticut In August 1989, epidemiologists from the New York State Department of Health (NYSDH) investigated five reports of generalized seizures temporally associated with topical use of N,N-diethyl-m-toluamide (DEET). Three of the case-patients, one from New York and two from Connecticut, were reported by a pediatric neurologist who practices in both states. One case was reported initially to an entomologist in New York, and one was reported directly to the NYSDH. The cases occurred in June through August 1989.

FROM:

DEET and Anti-Nerve Gas Drug Implicated in "Gulf War Syndrome"

An experimental anti-nerve gas drug that was prescribed by the Department ofDefense for 695,000 soldiers during the Persian Gulf War may have boosted the toxicity of N,N-Diethyl-m-toluamide (DEET) in the field, triggering veterans' symptoms known as Persian Gulf War Syndrome, Senate Committee staff members noted recently.

Last year, a USDA scientist who was conducting research on cockroaches found evidence that could have important implications for Persian Gulf War veterans, Senate Veterans' Affairs Committee staff members said at a May 6 committee hearing on hazards of military research. The scientist, Dr. James Moss, found that when used in combination with pyridostigmine, DEET became 10 times as toxic as when used alone. Senate Veterans' Affairs Committee staff members investigating the use of the anti-nerve gas enhancer pyridostigmine made a connection between DEET and other insecticides used by soldiers in the field to combat sand flies and scorpions, and their possible synergistic effects with pyridostigmine.

"I ask you not to create any undue or unnecessary alarm or panic," Giuliani said at a City Hall news conference on Thursday morning. "There's no point in not spraying, because there's no harm in spraying. So even if we're overdoing it, there's no risk to anyone in overdoing it...The more dead mosquitoes," he added, "the better. I don't think the media should try to push this out of proportion."

NY Times

9/10/99

 

The mayor dismissed complaints from environmental advocates about the spraying, referring to them as hysterical "environmental terrorists" who "like to get you angry because it gets them on television." The spraying is harmless, he insisted.

 

Mosquito War Protests greet new plan for spraying

Daily News

9/18/99

"I have nothing to hide," "I'm very comfortable with the spraying of Malathion. If we had to do it again, we would do it the same wayî. Jerome Hauer, director of the Mayor's Office of Emergency Management.

1/27/2000

Queens Tribune

Emergency Management Director Grilled On Mosquito Control

Mayor Rudolph Giuliani refused to rule out the need for widespread insecticide spraying in the event there is another outbreak this year...Seeking to blunt criticism of last year's spraying, Giuliani brought Deputy Mayor Rudy Washington to the podium at City Hall and said, "This man here, right here, was sprayed with malathion five times. See? Does he look good? All right? And I was sprayed with him. Five times." An aide later said that Washington and the mayor were subjected to five passes by a malathion-spraying helicopter while playing golf in Forest Park, Queens, during the outbreak. Neither mentioned any ill effects, the aide said.

Newsday

3/10/2000

Queens Find Spurs West Nile Fears

----------------------------------------------------

Contacts and sources of information:

For a leading expert on the toxicity and carcinogenicity of Malathion contact Dr. Robert Simon:

Environmental & Toxicology International

A division of Toxicology International, Inc.

11244 Waples Mill Road, Suite H2

Fairfax, Virginia 22030

(800) 296-7053 (703) 273-9621 facsimile (703) 273-9873

ETIRKS@aol.com

www.toxint.com

 

For information on fighting further spraying contact:

Joyce Shepard, CSW

Citizens' Action Committee for Change

E-Mail: CactionC@jps.net

Telephone: 718-279-2069

Facsimile: 718-279-3281

[NOTE: the opinions expressed above are those of the author]

*The Mayor's 4/27/2000 Town Hall Meeting was broadcast on Crosswalks ,the daily cable broadcast of NYC government events]

[This is the brand of Malathion Mayor Giuliani, OEM Director Jerry Hauer and Dr. Neal Cohen used on us last year.]

page 1 of label

page 2 Label

page 3 label

page 4 label

ANVIL LABEL

 

SCOURGE LABEL 1

SCOURGE LABEL 2

SCOURGE LABEL 3

--------------------------------------------------

FEEL FREE TO REPOST, FORWARD OR OTHERWISE DISTRIBUTE THIS INFORMATION. IF YOU OR A FRIEND WOULD LIKE TO BE SUBSCRIBED TO MAILINGS EXPOSING THE GIULIANI ADMINISTRATION'S MANY CRIMES AGAINST THE PEOPLE OF NYC SIMPLY SEND AN EMAIL TITLED: SUBSCRIBE.

SAVE THIS REPORT FOR YOUR OWN (OR YOUR LAWYER'S) FUTURE USE. BE ASSURED THEY INTEND TO SPRAY AGAIN. DON'T BE LULLED INTO COMPLACENCY OR FEARFUL INACTION. PROTECT YOURSELF AND ESPECIALLY YOUR CHILDREN FOR WHOM THESE CHEMICALS ARE ESPECIALLY TOXIC. CONTACT YOUR LOCAL MEDIA AND PRESSURE THEM TO COVER THE REAL STORY INSTEAD OF HYPING THE IMAGINARY EPIDEMIC EVERY DAY.

"Only puny secrets need protection. Big discoveries are protected by public incredulity."

Marshall McLuhan, in his 1972 book Take Today

---------------------------------------------

Robert Lederman is an artist, a regular columnist for the Greenwich Village Gazette [See: http://www.gvny.com/ for an extensive archive of Lederman columns] The Shadow, The Vigo-Examiner [see: http://www.vigo-examiner.com/archive.htm ] and Street News, and is the author of hundreds of published essays concerning Mayor Rudolph Giuliani. Lederman has been falsely arrested 41 times to date for his anti-Giuliani activities and has never been convicted of any of the charges. He is best known for creating hundreds of paintings of Mayor Giuliani as a Hitler like dictator.

Robert Lederman, President of A.R.T.I.S.T.

(Artists' Response To Illegal State Tactics)

ARTISTpres@aol.com

(718) 743-3722

http://www.openair.org/alerts/artist/nyc.html

Also see:

http://www.levymultimedia.com/lederman/index.htm

for Lederman's essays on Malathion and the spraying of insecticides on NYC

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