Like countless New Yorkers, Michael Crane, MD, MPH, has his own personal story about the morning of Tuesday, September 11, 2001.

A doctor and public health expert then working for Con Edison, he made his way to Ground Zero on that day. Over the next several weeks, he helped ensure that the company’s workers took proper precautions during the recovery operations. Like thousands of other responders, they were exposed to hazardous conditions, toxic agents, and extreme psychological stress.

As it turns out, safeguarding the health of workers who were at Ground Zero would continue to be a focus of his life and career 25 years later. Mount Sinai had been caring for 9/11 responders since 2001, and he went on to serve as Medical Director for the World Trade Center (WTC) Health Program Clinical Center of Excellence (CCE) at Mount Sinai after the federal WTC Health Program was formally established in 2011.

These days, Dr. Crane’s primary responsibility is overseeing Mount Sinai’s program, which monitors and cares for more than 27,000 first responders in the New York City area. Mount Sinai is the largest of eight Clinical Centers of Excellence that care for about 95,000 responders—firefighters, police, recovery, and cleanup workers and many others who participated in rescue and recovery efforts.

The other New York metropolitan area Centers of Excellence that serve responders are run by the State University of New York at Stony Brook, Rutgers University, Northwell Health, and the New York University Grossman School of Medicine, along with a Fire Department of New York center exclusively for New York City firefighters. These Centers were established to monitor, treat, and support rescue and recovery workers who responded on September 11 and in the following weeks and months.

“Unless we get as many responders as possible, we won’t know the full impact of what happened to these folks,” says Michael Crane, MD, MPH, Medical Director for the World Trade Center (WTC) Health Program Clinical Center of Excellence (CCE) at Mount Sinai. “We need all the data we can get. That’s the real goal when you have an exposure that is unknown.”

These Centers are part of the national WTC Health Program overseen by the U.S. Centers for Disease Control and Prevention. The WTC Health Program is authorized and funded through 2090 under the James Zadroga 9/11 Health and Compensation Act, signed into law in January 2011, and reauthorized by Congress in 2015. Mount Sinai’s World Trade Center Clinical Center of Excellence is located within the Mount Sinai Selikoff Centers for Occupational Health.

The WTC Health Program also oversees programs for survivors—those who lived, worked, or went to school in downtown Manhattan. There are now more than 145,000 people enrolled in the WTC Health Program, including about 57,000 survivors and 95,000 responders. The program also funds medical research into the physical and mental health conditions related to 9/11 exposures.

As the New York region marks another significant anniversary of the attacks, Dr. Crane says Mount Sinai’s Clinical Center of Excellence continues to see new members and encourages other responders who may not yet have sought care to enroll in the program. Staff at Mount Sinai’s Center  are available to assist with enrollment in the WTC Health Program.

In this way, Mount Sinai and the other Centers are building on the lessons of public health, which is to follow the lead of those on the ground in identifying possible concerns, gather data, provide care, and use research to understand the results, all while demonstrating a commitment to safeguarding the public  and building trust and confidence in the communities affected.

Still, Dr. Crane says he hopes more responders will decide to participate in the program.

“Unless we get as many responders as possible, we won’t know the full impact of what happened to these folks,” says Dr. Crane, who is also a Professor in the Department of Environmental Medicine at the Icahn School of Medicine at Mount Sinai. “We need all the data we can get. That’s the real goal when you have an exposure that is unknown.”

From the beginning, Dr. Crane and other health care experts knew there would likely be long-term respiratory troubles for first responders. A compounding factor would be the heroic efforts of first responders, many of whom would not stop working at the site even when they worried about possible medical issues.

One of the most striking initial symptoms among these responders was “a thunderous cough that would not stop,” which came to be known as the WTC cough.

“I had never heard anything like it,” he says. “It was a sign of healthy people having trouble clearing out their airways, and some of them getting quite distressed.”

In their monitoring of both first responders and survivors, public health officials continue to see respiratory conditions, specifically chronic rhinosinusitis (an inflammation of the sinuses), and asthma, among the top five conditions. Other leading conditions include gastroesophageal reflux disease (GERD), cancer, and post-traumatic stress disorder (PTSD). To address these and other mental health concerns, the WTC Health Program provides mental health services to eligible members.

Of note, cancer has become an increasingly important part of the program’s work, with more than 25,000 responders and 27,000 survivors nationwide being diagnosed with cancer, according to the program. Some of the most frequently covered cancer conditions treated by the program include non-melanoma skin cancer, prostate cancer, breast cancer, melanoma, and lymphoma.

The WTC Health Program covers yearly monitoring for those enrolled and treatment. Regular monitoring is important because many of these conditions may develop years after exposure, experts say. It’s also important to build relationships with clinicians who can track these patients over time and to ensure there are no obstacles to care that might discourage regular monitoring.

Another critical element of the WTC Health Program is that it generates data that has been the basis of publications by researchers. Recent findings by the Mount Sinai team indicates PTSD may accelerate brain aging in 9/11 responders, and that harmful substances, contaminated environments, and hazardous materials may contribute to conditions such as PTSD, GERD, respiratory disorders, diabetes, and chronic headaches.

For those who seek out monitoring and care, the prognosis can be promising, even for those facing more complex conditions and cancers. This care has included lung transplants, according to Dr. Crane.

“If you come to the program, I am optimistic that you will find the best care available anywhere. We will strive to optimize your lifespan and optimize the joy that you have in that life while you’re living it,” he says. He hopes doctors will continue to refer patients to the WTC Health Program.

In fact, multiple studies show the value of this ongoing treatment. For example, a study of more than 28,000 responders found that those enrolled in the WTC Health Program had a 13 percent lower risk of death. The study was published in the Annals of Epidemiology in March 2026.

Dr. Crane also expresses concern for the group of survivors who lived in downtown Manhattan and returned to live there in the weeks and months after the attacks. Health authorities believe this group of people may be as large as 400,000, and the effects of longer-term exposure to lower levels of environmental hazards that come from living many years downtown with the residual environmental effects are not known, according to Dr. Crane.

The World Trade Center Environmental Health Center at NYC Health + Hospitals and the William Street Clinic assess and treat these survivors, which includes residents, students, workers, or passersby who may be sick from  9/11-exposures.

Dr. Crane says those who lived in lower Manhattan during this period should consider applying to the WTC Health Program and get their 9/11-related symptoms monitored. He hopes increased participation in the program will help public health authorities expand the data they are now collecting on possible longer term health effects, especially for young children who were exposed for longer periods while they were growing up and their bodies were developing.

“The pollution from the collapse of the buildings was significant,” Dr. Crane says. “It’s an ongoing concern for all of us in the program given what we are seeing with the responders. These folks who lived in the community may have had somewhat lower-level but longer-duration exposure. We’re especially concerned about those young people whose bodies were changing in the presence of toxins.”

During the early years, survivor enrollment in the program had lagged significantly behind the responder enrollment, but this has been changing over the last decade. Survivors now represent more than 39 percent of the total number of program participants. Experts believe this is probably the result of greater awareness of the program, and the delayed onset of some medical conditions. About 59,000 participants are survivors, compared with about 95,000 responders.

“We hope that people will join and participate because we think there may be problems there,” Dr. Crane says. “Quite frankly, we don’t even know what they are.”

About the World Trade Center Health Program

The WTC Health Program is a limited federal health care program that provides health care for certified WTC-related health conditions at no out-of-pocket cost to those directly affected by the September 11 attacks in New York, at the Pentagon, and in Shanksville, Pennsylvania. The program was established by the James Zadroga 9/11 Health and Compensation Act of 2010. It is administered by the National Institute for Occupational Health and Safety (NIOSH) part of the Centers for Disease Control and Prevention in the U.S. Department of Health and Human Services. To learn more about the WTC Health Program, click here.

If you peered through the window of Studio 5 at Ballet Academy East on the Upper East Side, and watched these ballet dancers moving under the watchful eyes of their young instructors, the class might seem like countless other classes in New York City. 

But this class is different.  

The kids all have autism spectrum disorder (ASD). And the instructors are three medical students at the Icahn School of Medicine at Mount Sinai, located just a few blocks from the studio. 

Struck by the rise in ASD and motivated by a shared love of ballet, the medical students are replicating a successful ballet curriculum created by the California-based nonprofit Ballet for All Kids, which has been implementing its program for children with developmental differences for close to a decade.  

The students, Noy Alon and Camila Vicioso, both third-year medical students, and Michelle Adler, who is in her fourth year of a combined MD/PhD program, set out to create a program geared toward children ages 6 to 12 years old with a diagnosis of ASD, regardless of severity level or other medical conditions. Each semester features two 45-minute classes, one tailored for beginners and one for returning students.   

“I have been working with Ballet for All Kids since 2020. When I came to Mount Sinai, I knew I wanted to bring this program to New York City, so I partnered with two amazing fellow student founders,” says Ms. Alon, who has been dancing ballet for 14 years. 

“Children with autism can have difficulty with balance and joint mobility. Ballet is uniquely suited to help them with both of these challenges, and this incredible program meets children where they are,” says ​​​​Sheena Ranade, MD, Associate Professor of Orthopedics, and Pediatrics at the Icahn School of Medicine and Division Chief, Pediatric Orthopedic Surgery. Dr. Ranade is a faculty advisor and mentor. 

The program offers a free 12-week ballet curriculum, with funding support from the American Psychiatric Association Foundation’s Helping Hands Grant and the Klingenstein Third Generation Foundation. The funds cover the cost of securing ballet studio space, providing transportation assistance for families, and purchasing ballet slippers for each child.  

The initial results appear promising. 

Adalia Richardson said she saw improvements in her 12-year-old daughter, Isabella, now in her second year of participating in the program, noting improvements in confidence and coordination. “She’s done amazing and made so many friends,” she told WCBS-TV. 

In response to the overwhelming enthusiasm from families, the children’s eagerness to continue ballet, and a long waiting list, the team hopes to establish long-term continuity and sustainability for the program. 

The ballet program combines community outreach, clinical benefits, and rigorous research to support children with ASD. “Many children with ASD have limited access to recreational activities that are adapted to their needs, despite the important role movement, routine, and community can play in development,” says Ms. Vicioso, who has been dancing ballet since she was two years old. 

Camila Vicioso, Noy Alon, and Michelle Adler

The three students first offered the classes two years ago in partnership with the Seaver Autism Center at Mount Sinai, under the leadership of Clinical Director Alexander Kolevzon, MD, Professor of Psychiatry, and Pediatrics at the Icahn School of Medicine.  

“The ballet program addresses a critical and often unmet need for kids with autism to experience meaningful recreational programs that build social skills,” says Dr. Kolevzon. “As a bonus, we’ve been pleased to see how families have fostered a strong community around the ballet program.”  

The program has now completed four semesters and has included more than 40 families and 20 medical student and graduate volunteers from Mount Sinai, who provide one-on-one support for each child, allowing for individualized teaching within a structured environment that prioritizes having fun. The classes are taught by the three founding students alongside a new member of the leadership team, Eliana Elikan, a second-year student. 

Thinking about the discipline, focus, and strength required of ballet from their own experiences, the team was also interested in studying how a structured recreational ballet program for children with ASD could have positive outcomes in both mind and body. The co-founders worked together to start a randomized controlled trial under the name Approach to Dance for Autism (ADAPT). 

“As the prevalence of diagnosed ASD continues to rise, recreational movement programs are highly relevant to pediatric musculoskeletal care,” the founders wrote in an article in the Journal of Bone and Joint Surgery, published in November 2025.   

So far, their data has shown improvements in balance and motor skills, coordination, attention and engagement, and psychosocial skills following the 12-week ballet curriculum, along with high adherence and attendance to the classes. Early insights from the pilot study have also informed multiple international presentations and an ongoing manuscript currently under review.  

“Every kid comes into our class at a different starting point, and what makes this program so special is that for each child, we devise an individualized plan. I believe that every child who participates in this program will gain something meaningful, whether that’s physical skills, confidence, or a sense of connection,” says Ms. Adler, a ballet dancer since she was two years old. Growing up with a sister with Down syndrome, she saw firsthand the impact of communities who come together to support their kids. 

“Seeing our students taking something they have loved for so many years and bringing it to a community that hasn’t had easy access to ballet and other recreational opportunities is just amazing.  It reflects the strong commitment at Mount Sinai to engaging with our community,” says Dr. Kolevzon.