Gina Solomon's Blog: Health and the Environment

Bisphenol A: Is it Gone? What's Next?

2008-04-18T21:27:39Z

The dominos are really starting to fall, as major manufacturers and retailers line up to announce that they are removing bisphenol A (BPA) from their products, or are pulling these products from their shelves. Although it’s gratifying to see this happening, it’s my job to always keep a weather-eye on the horizon and to worry about what’s next. Do the announcements by Nalgene and others today really solve the problem?

Not quite yet....

For years, we have been working to painstakingly pull together the science on BPA and to make the case to various regulatory agencies and legislative bodies (mostly unsuccessfully) that they should pay attention to what the science shows. For over a year we have had guidelines on our website telling consumers what they can do to avoid BPA. Meanwhile, studies by the Centers for Disease Control and Prevention (CDC) have showed that almost all Americans have this chemical in their bodies at levels that are likely to be significant. It’s frustrating to look at the science and then to look around you at the world and realize that nobody knows, and the key people don’t seem to care. It’s worse than frustrating when you realize the implications of the science could mean significant health problems ranging from promotion of breast cancer, to abnormalities of reproductive function, to alterations in fat storage in the body (ie. obesity).

When the tipping point finally happens, and BPA becomes a household name, that’s a good thing, because consumers and the public can finally drive agencies such as the EPA to do what they should have done years ago. Better still, companies take action right away when they realize the writing’s really on the wall.

There are two remaining problems that I’m worrying about today. One is that what is probably the biggest source of BPA seems to be entrenched and isn’t making a change, and the other is that we need to be wary of moving from the devil we know to the devil we don’t.

Some studies suggest that the biggest exposures to BPA come from eating canned food and drinking canned beverages. If you open a can of tomato sauce, empty it out, and peer inside, you’ll see a beige material lining the inside of the can. This stuff is a polycarbonate resin that’s designed to help prevent the metallic taste from the can from getting into the food. Since BPA imparts no flavor, it’s a great choice as the building block of this lining – except for the inconvenient fact that it’s toxic. Take a flashlight and peer deep within a soda can; you’ll see the same beige lining. Yet the canned food industry says they haven’t found an alternative yet, so the consumer will have to wait. Or maybe not...since we can buy our tomato sauce in glass jars or cardboard boxes and our vegetables frozen.

A while ago, the Sigg company removed the BPA lining from their nifty stainless steel water bottles. They were ahead of the curve and deserve special praise for their foresight. We withheld our praise, however, when they refused to disclose what chemicals they were using instead. Nalgene’s announcement today garnered lots of public attention, but my attention went to their “Tritan copolyester”, with questions about what’s in it. Camelbak has similarly announced their “genderbender free” bottles (love the name!) without disclosure of ingredients.

The real issue here is that two principles need to be put into place in the consumer marketplace:

First, chemicals that go into consumer products need to be tested for safety before they are put in the products, so we don’t have to wait for years before we discover that a chemical’s a problem.
Second, consumer products should all be required to list ingredients. That way, scientists like me can evaluate what’s in things and whether they’re safe, and the informed public can read the label if they want to avoid any particular ingredients.

We’ve got labeling on food, why can’t we do it with other consumer products?

Federal Agency is First to Acknowledge Risks of Plastic Chemical

2008-04-15T00:45:11Z

The National Toxicology Program (NTP) today released a draft evaluation of the widespread chemical, bisphenol A, becoming the first federal agency in the world to express concern regarding this chemical’s potential to cause harm to fetuses, infants and children.

Bisphenol A (BPA) is an endocrine disrupting chemical used in many consumer products, including polycarbonate plastics (ie. hard clear plastic bottles), the lining of food and beverage cans, and dental sealants. It is a high production volume chemical with approximately 2.3 billion pounds produced in the US in 2004. The large production volume and use in common consumer products means that we’re all exposed to the stuff. BPA has been detected in 93% of over 2,500 urine samples collected by the Centers for Disease Control. BPA has been measured in all human biological fluids, including blood, urine, breast milk, and amniotic fluid.

NTP states that there is “clear evidence” that at high doses bisphenol A is a developmental toxin, capable of causing death in newborn animals, reduced growth in the womb and in early life, and changes in the age of puberty. This will likely be enough to trigger listing of bisphenol A on California’s list of chemicals recognized by the state to cause developmental or reproductive harm. That would mean that – at least in California – consumers would need to be informed when they are exposed to this chemical, and the chemical would be banned from discharge into sources of drinking water. NTP also expresses some concern that current levels of exposure to bisphenol A can cause changes in behavior and the brain, prostate gland, mammary gland, and the age at which females attain puberty in fetuses, infants and children.

Chemical evaluations from the National Toxicology Program are used by state and federal regulators to set clean up and exposure standards. Other agencies have relied on industry studies that downplay the health risks of this chemical, In fact, the NTP was heavily criticized by NRDC and other groups for hiring a consultant with conflicts of interest to prepare the original draft, and about inaccuracies and inconsistencies in the characterization of the science in prior drafts. In this final version, NTP has incorporated independent studies of this chemical instead of relying just on the industry reports.

According to my colleague, Sarah Janssen, a physician and reproductive biologist who is an expert on endocrine disruptors: “This is the first government agency to affirm that this chemical is a problem for developing children, which is something we’ve been suspecting for years.” She added “NTP should finalize this report quickly and the government should take action to protect public health.” I completely agree.

The PDF version of the report is available here.

Lead in Toys and in our Air

2008-03-31T22:57:39Z

I just got back from a visit with my adorable 9 month old nephew in Florida. It was fun to hold him and play with him. He’s even starting to crawl, and we got some great photos and video of the key moments. Like any auntie, I came bearing gifts. Of course, each one was carefully scrutinized for hazards – especially for potential contamination with lead. Lead contaminated toys have been in the news so much over the last year that you’d have to live under a rock not to be aware of that problem. I wasn’t going to risk bringing even a small amount of lead into Johnnie’s house, since I know how dangerous lead can be to the developing brain of a young child.

During the visit, we explored the local area and even took a short drive to see the manatees snoozing in the warm waters near the local power plant. Yet even I (obsessed with pollution as I am) didn’t check on the local polluters until the end of the visit. I was disturbed by what I found.

A few miles down the road from my 9 month old nephew, there’s a big orange dot on our map of lead polluters. Progress Energy, Inc. pumps out 2,643 pounds of lead into the air each year. That’s over 2 ½ tons of lead into the air right near where Johnnie’s little vulnerable lungs are breathing. The other power plant – the one making warm soup for the manatees – puts out another three-quarters of a ton of airborne lead. An additional half-ton of lead comes from the small planes running on Avgas at the local municipal airport just a few miles from Johnnie’s house. Most people don’t know that small aircraft still burn leaded gasoline, even though it was banned for cars many decades ago. Studies have shown that some communities downwind from airports have significantly elevated lead levels in the soil due to deposition of airborne lead particles.

Today – back on the job – I wrote technical comments to the EPA about the design of the monitoring network for airborne lead pollution. One of EPA’s analyses showed that a single source that emits about 60 pounds of lead (that’s only 0.03 tons per year) could result in air levels that exceed the most health protective levels that EPA’s scientific advisors are recommending to guard children’s health. Now I’m trying not to be nitpicky, but the amount of lead coming out of Johnnie's two local power plants and the airport adds up to over 85-times the 60 pound threshold. Of course, most of the lead is probably blowing offshore to poison the manatees instead of my nephew, but it would be nice if there was less lead blowing around in the air.

The thing that saddens me most is that things are pretty good in my nephew’s neighborhood, relatively speaking. Many kids have it far worse, with much more lead pollution sprinkled through their communities. So let’s keep buying the lead-free toys for our kids, but let’s also support more stringent government standards to control the lead that we aren’t buying – the lead from the polluters down the street.

To look for lead polluters near you, check out: Get the Lead Out!

Your Friendly Neighborhood Lead Polluter

2008-03-24T17:26:30Z

The town of Herculaneum, Missouri is a big red blotch on the map. Leslie and Jack Warden, raised their son there, less than a mile from the Doe Run lead smelter. Their son has Attention Deficit Disorder (ADD). Her niece and nephew, who lived just one block away, were both diagnosed with lead poisoning. For years Mrs. Warden said that she and all her neighbors assumed that everything was OK in their small town, since “that’s what everyone from the government told us”.

In 1999, when they finally learned about the widespread air and soil pollution, and all the children with lead poisoning, they felt duped and betrayed. The latest blow came this year when EPA announced that it is considering eliminating the air quality standard for lead. When she heard the EPA announcement, Mrs. Warden said: “Then why don’t they just put it back in gasoline or in paint? They think it’s OK to use our children as lead monitors; that would be the only air monitor we’d have left in this community is our children.”

She is right. If EPA eliminates the air quality standard for lead, they will also finish dismantling the national lead air quality Compliance Monitoring Network. Then we will have no way of knowing which counties have lead problems, and how high the levels are in our air. The first hint of a problem will be when children in our communities get lead poisoning, and that’s too late.

Find out if one of the more than 16,000 lead polluters is in your neighborhood by checking out these lead polluter maps.

Air pollution standards: Will the next debacle be about lead?

2008-03-17T22:01:31Z

This past week, the EPA gave itself another black eye by adopting a standard for ozone (smog) pollution that EPA science advisors say is inadequate to protect human health or the environment. Check out the Washington Post story here. Worse still, documents have since come out showing that the White House trumped both the scientists and the EPA -- requiring the Agency to issue a weaker rule than originally intended.

I care a lot about ozone air pollution, since I see asthmatic people all the time who are affected on "spare the air" days, and I know the scientific evidence that shows how unhealthy the current ozone standard is for my patients. But I'm also really worried about the signal this sends for other important air quality decisions in the EPA pipeline over the coming months.

The EPA air quality standard for toxic lead was set in 1978. Decades of science later, it's now clear that the 30 year old standard won't protect children's health. A great community group, the Missouri Coalition for the Environment, sued EPA to force them to revisit this outdated standard. Now EPA must act by September. You might think this will be a good thing, since lead is generally recognized to be the number one environmental threat to children's health. But this Administration has shown how much it cares about human health when it set the ozone standard last week.

In fact, the EPA Administrator is seriously considering alternatives that include completely eliminating the air quality standard for lead, or keeping in place the 1978 standard. These proposals are totally at odds with the unanimous opinion of two EPA scientific advisory committees. We expect a formal proposal from EPA within the next month.

Stay tuned for this key decision. We'll need all the help we can get if EPA proposes to throw public health out the window again.

Eco-Consumers and Health

2007-11-01T22:24:33Z

On Halloween day, 43,000 sets of "Ugly Teeth" party favors were recalled due to dangerous lead contamination. This piles on top of recalls of candy collection buckets, Frankenstein drinking goblets, and more lead-tainted toys. Now that's really a Halloween scare!

What you buy might hurt you. I'm not talking about guns or cigarettes, but instead about regular consumer products that are out there looking appealing and innocent on store shelves.

Many of the lead-contaminated products are imported from China, creating an obvious target for consumer concern. A Chinese guy that I know jokingly had a t-shirt made that says: "Dangerous Chinese Import". Pretty cute. But the fundamental problem isn't just about tainted imports. Yes, there are serious concerns about weak environmental, labor, and safety standards in other countries and the long supply chain diminishes accountability, so companies often don't really know what's in their products. But more fundamentally, consumers are waking up to the fact that there are really deep problems in the ways that consumer products are tested, regulated, and controlled. As a result, buyers are starting to beware.

The New York Times reports on young "Eco-Consumers" asking tough questions about ingredients in cosmetics. These young women are savvy to the health risks from hidden endocrine disrupting chemicals such as phthalates. They are also aware that just because a product is labeled as "natural" doesn't mean it's safe. Most importantly, these consumers understand the importance of full disclosure -- they read the label, and they want to see a full list of ingredients before they buy.

Although some companies are responding to this new wave of consumers, I remain dubious about the long haul, unless we can get some real regulatory change. After all, the "Ugly Teeth" didn't have lead on the label, and phthalates often legally hide in cosmetics under the inocuous-sounding term "fragrance". What's a consumer to do?

My philosophy is to think before I buy. My first question is: "Do I really need this?" If the answer is "probably not", then I save my money for something I really need (like chocolate!). If I really need the product, I look for one that has a short list of ingredients, and preferably one that's fragrance-free. How many ingredients do you really need to make a good shampoo, after all? For some products, such as cosmetics, various independent groups have provided excellent resources for consumers. For example, check out the Safe Cosmetics Campaign's searchable "Skin Deep" database.

So skip the "Ugly Teeth", and maybe also skip some of those other products beckoning from the shelves. After all, for consumers, low price isn't everything.

White House Meddling in Health and Global Warming Science

2007-10-24T20:21:55Z

What is it about global warming that the occupants of the White House don't seem to understand? It's beginning to seem like the only people who just don't get it are a few people in big buildings in Washington. Only two weeks after the Nobel Peace Prize was awarded to the Intergovernmental Panel on Climate Change (IPCC) for describing how global warming will affect the planet and human health, the White House is now censoring scientific statements based on their work.

In the latest round of meddling, White House censors yesterday gutted the testimony of the nation’s leading public health official – Dr. Julie Gerberding, the director of the Centers for Disease Control and Prevention - by slashing more than half of her testimony to the Senate on the health effects of global warming. Read more about it in the Washington Post here and in the Associated Press here.

The White House completely eliminated seven pages of testimony on the health impacts of global warming, including explanations and descriptions of the links with heat stroke, weather disasters, worsening air pollution and allergies, food- and water-borne infectious diseases, mosquito and tick-borne infectious diseases, food and water scarcity, mental health problems, and even chronic disease. Perhaps the White House doesn’t want the U.S. public to know that climate change will directly affect their health and their lives.

Dr. Gerberding’s original testimony also explained that the burdens of global warming will fall on certain vulnerable populations. Her original testimony included the following detailed information on who is most at risk, which the White House seemingly doesn’t want people to know: "Children are at greater risk of worsening asthma, allergies, and certain infectious diseases, and the elderly are at higher risk for health effects due to heat waves, extreme weather events, and exacerbations of chronic disease. In addition, people of lower socioeconomic status are particularly vulnerable to extreme weather events. Members of racial and ethnic minority groups suffer particularly from air pollution as well as inadequate health care access, while athletes and those who work outdoors are more at risk from air pollution, heat, and certain infectious diseases." Yikes, that sounds like most of us! I guess that's the problem.

The original CDC testimony also included the following statement, that was removed by OMB: "Scientific evidence supports the view that the earth’s climate is changing. A broad array of organizations (federal, state, local, multilateral, faith-based, private and nongovernmental) is working to address climate change. Despite this extensive activity, the public health effects of climate change remain largely unaddressed. CDC considers climate change a serious public health concern." Apparently the White House does not agree that CDC should consider climate change a ‘serious public health concern’.

The science on the health effects of global warming is growing stronger and more urgent every day. It’s beginning to seem like everyone understands these connections except the occupants of the White House. As wildfires burn in Southern California threatening homes and lives, and the water supply in Atlanta is draining dry, the White House is apparently trying to duck the inevitable question – are we already seeing the direct health effects of climate change today?

In case anyone's curious, take a look at the original testimony by the CDC director, and the gutted testimony that she gave yesterday to the Senate.

Sneezing and Wheezing: Ragweed, Ozone, and Global Warming

2007-10-17T14:22:47Z

Asthma and allergies are among the most annoying and even disabling common health problems. About 36 million Americans suffer from some kind of allergy, and about 17 million people have asthma. These diseases result in millions of missed school days, missed work days, and hospitalizations... not to mention plain old misery and suffering. As an allergy sufferer, I have personal experience dealing with this from both the doctor's and the patient's perspective. Not fun either way.

So when the science started emerging that ragweed -- that most noxious of allergens for those of us with late-summer symptoms -- will thrive with global warming, I was pretty annoyed. It seems like with global warming, the hits just keep coming. Researchers from Harvard and the U.S. Department of Agriculture tried growing ragweed in greenhouses and exposing the plants to the levels of carbon dioxide that we experienced in pre-industrial times, the levels in the air today, and the levels expected by about 2050, and they found that the nasty weed produced about 130 percent more pollen today and will produce about 300 percent more pollen in the future. Worse still, the warmer temperatures may allow this weed to spread to new areas. You can read one of their studies here.

But it's not just ragweed that's linked to global warming. And it's not just pollen that hurts allergy sufferers. Ozone smog is also sensitive to temperature. That's why the smoggiest days are always the hot days of summer. Despite efforts to control air pollution, global warming is projected to reduce or even eliminate a lot of the efforts to control smog, and it may even make ozone pollution worse.

So here's the kicker: other scientific studies show that ozone and pollen seem to have a synergistic effect, so when people with allergies are exposed to both (instead of just one or the other), they get far more serious reactions.

My team of researchers at NRDC decided to take a look at this issue. We mapped the areas in the U.S. where ragweed has been reported, and we mapped the areas where ozone levels have exceeded the national standards within the past five years. Then we honed-in on the overlap zone. That overlap zone is pretty big, and it encompasses 309 counties where 150 million people live. It includes the Los Angeles basin, the Mississippi River basin, the Great Lakes states, and the entire Atlantic seaboard from Georgia to Maine. These are areas where people are living today with the "double-whammy" of ozone and ragweed pollen.

It's hard to say how much worse things will get in the future, but it's reasonable to be concerned. People with allergies and asthma might want to learn if they live in a zone where there's ragweed or ozone problems, and whether they're sensitive to ragweed. Here's some advice if you want to be prepared for ragweed season. For more information about ozone, and what can be done about it, check out this ALA factsheet.

Fundamentally, what we need is some government action to reduce ozone levels by bringing the National Ambient Air Quality Standard (NAAQS) down to a level that will protect human health, and reducing sources of pollution. At the same time, we need action to stop global warming and reduce carbon dioxide pollution. Can we do it?

Why Won't Toxic Lead Just Go Away?

2007-10-12T23:55:28Z

So today we learn that lead is in lipstick. In recent months we've read about lead in children's toys, lunchboxes, contaminated candy, children's costume jewelry, and many other common products in our homes. Will it ever end?

Since the days of the Pharaohs, physicians have known that lead is a dangerous metal. Lead poisoning is described in the oldest medical textbooks. Yet this stuff just never seems to go away. Getting rid of toxic lead is kind of like killing the many-headed Hydra. Many of us working in the area of environmental health feel like we've spent a large part of our career clubbing the heads of this monster. I'm proud that I had a role in helping to virtually eliminate lead from calcium supplements, antacids, water faucets, and water meters. Every little bit helps...

One of my heroes is Dr. Alice Hamilton, the founder of Industrial Medicine and the first woman professor at Harvard medical school (she joined the faculty in 1919). In the 1920's, Dr. Hamilton campaigned against the addition of lead to gasoline. She argued that the toxic effects of high-dose lead were well-known, and that the dispersion of lead throughout the environment was a really bad idea. Of course, history has proven her right in spades, but at the time her concerns were dismissed as completely overblown and hysterical.

It took decades of painstaking scientific research to prove what we now know definitively - that extremely low levels of lead are dangerous to health, especially to the normal neurological development of children. Worse still, there's no 'threshold' to the noxious effect of lead, so any dose is adverse, no matter how small. It took more than 50 years to finally ban lead from gasoline, paint, water pipes, and the solder in food cans.

For public health providers, it is gratifying that the average lead levels in children's blood have fallen dramatically over the past 30 years since the ban on lead in gasoline. When I was a child, the average blood lead level was about 17 micrograms per decileter. Now a child with a lead level that high would be clearly diagnosed as lead poisoned, and the average blood level in children is around 2. The figure (courtesy of the EPA) at the bottom of this page shows how children's blood lead levels dropped in parallel with the phase-out of lead in gasoline. The economic benefits to society from this decline have been estimated at $319 billion, and the health benefits for countless people are unquantifiable.

Yet here we are today, with all the scientific knowledge in the world about the awful health and economic toll from lead poisoning, and we're still finding lead in consumer products on an almost daily basis. I have to say, it turns my stomach. The problem here is not a lack of scientific evidence, and it's not a lack of education. The problem is a lack of regulatory oversight and enforcement dedicated to protecting the health of consumers.

The Environmental Protection Agency and the Consumer Product Safety Commission (CPSC) were created in order to protect us from dangerous chemicals, and from hazardous products. If they can't even protect us from lead, what exactly are they doing? There's an effort afoot right now in Congress to reform the CPSC, and it's long-overdue. These agencies need the legal mandate, the staff, and the sheer will-power to stand up to the polluters who want to cut corners at the consumer's expense.

If you want some basic ideas about protecting your children from lead poisoning, check out this resource. To learn more about current efforts to reform the CPSC, check out this blog post and this article.

Chemicals, Fragrances, and Sensitivity

2007-10-10T22:04:18Z

When we released our report on air fresheners a couple of weeks ago, I was focused mostly on two issues: (1) the worrisome fact that consumers have no right to information about what's in common household products and that these products aren't adequately tested for safety, and (2) the discovery that hormone-disrupting chemicals and potential reproductive toxicants such as phthalates may be in common household products.

Since the release of the report, I have gotten calls and emails from many people about the report. To them, the problem isn't the endocrine disruptors. It's the fragrances. For folks who think that the smell of "Summer Breeze" or "Forest Rain" is pleasant and unoffensive, it's a surprise to learn that many people find that these artificial fragrances make them sick. Literally.

Ever since I was a resident, training in the field of Occupational and Environmental Medicine in the mid-1990's, I've been puzzled by the syndrome that goes by various names, but is most frequently called "multiple chemical sensitivity" (MCS). People with this syndrome report a variety of nasty symptoms ranging from headaches and confusion, to respiratory symptoms, to gastrointestinal problems, when they are exposed to various common environmental chemicals. Triggers may include diesel exhaust, cigarette smoke, gasoline fumes, cleaning products, perfume, and...yes...air fresheners.

Most medical associations basically recognize the existence of this phenomenon, but differ as to whether it is a "real" disease. The result is that sufferers often bounce around between mainstream and alternative health practitioners looking for someone who will take them seriously. Sometimes the ones that take them seriously also take a lot of their money, and sometimes for some fairly dubious treatment approaches. These alternative treatments further contribute to skepticism from the mainstream medical community.

My approach to clinical medicine is fairly mainstream. Yet from my experience, I think that there really is something going on with many of these people. I believe that the fragrances and other chemicals are triggering some kind of adverse reaction, and I don't think that people with this condition are nuts. From there, my multiple internal personalities diverge:

--The scientist in me is frustrated because there is so little 'hard data' on this syndrome, and because the standard testing results on sufferers usually ends up looking fairly negative. I hate it when I can't explain what's going on with my patients.

--The health care provider in me is at once somewhat reassured because this syndrome is not fatal, and in my experience, many people gradually improve with time. But at the same time, I worry because sufferers lives are terribly disrupted, and there is little that I can offer to help alleviate their symptoms.

--The activist in me is appalled that we live in a world where it is virtually impossible to live one's life without being assaulted by blasts of diesel exhaust and second-hand smoke (which are dangerous by any measure), and where unnecessary artificial fragrances are ubiquitous in stores, hospitals, schools, and many other public spaces.

In my opinion, there's a lot we still need to learn about the effects of chemicals and fragrances on the human body. There's also a lot we still need to learn about individual susceptibility to environmental insults. Meanwhile, I try to be respectful of my fellow human beings. So I think twice before reaching for the perfume or the scented cleaners. For them it's a simple request: "Think before you stink"!

Eat Fish or Don't Eat Fish?

2007-10-04T18:06:28Z

Everyone seems to be buzzing about the latest round in the "fish wars". So I'll wade into the fray with my own perspective on this issue. I've spent a lot of time looking at the data on both the benefits and the risks of fish consumption, and I get questions on this all the time from my patients, and even from moms on the street.

In my view, this issue is pretty straightforward, so I'm often amazed at all the flap. The bottom line is that research convincingly shows that omega-3 fatty acids are good for the development of the baby's brain. Research also convincingly shows that mercury is bad for the development of the baby's brain. Nobody has yet conclusively demonstrated the 'perfect balance' between the risks of mercury and the benefits of omega-3s, and the opinions vary. Hence the announcement today that disagrees with the FDA and EPA guidelines.

But let's step back for a moment and use a little common sense. Any intelligent mother-to-be is perfectly capable of picking and choosing what she eats, and with very little effort she can get plenty of omega-3s and very little mercury. So why argue?

For example, there are fish like salmon and sardines that are chock full of omega-3s, and have almost no mercury. Moms - dig in! Also, for mothers that don't like fish, can't find good local fish, or are worried about mercury, the fish oil supplements have been tested and found to be virtually mercury free and also seem to be low in other worrisome pollutants. I sometimes recommend fish oil supplements to new moms.

Vegetarians don't need to worry. Omega-3 fatty acids are found in flax seeds, flax oil, canola oil, walnuts, beans, dark green leafy vegetables and fortified foods such as eggs (if you eat them), bread, and juice. It's harder to get enough Omega-3s if you're a vegetarian, but that just means you need to pay a bit more attention. It's not really a problem.

So do I agree or disagree with the announcement today saying that women should eat more fish? Yes on both counts - I both agree and disagree. There's no controversy about the need for Omega-3 fatty acids. But the devil's in how you get 'em. Telling women to just eat any old fish does a dis-service to those people who don't understand the risks from mercury. It also insults women's intelligence. By all means, make sure you're getting enough Omega-3s, but do it your way, not theirs. Pick among the menu of alternatives, but pick sparingly from the high-mercury end of that menu.

This debate is really similar to lots of other "controversies" in environmental health. People debate endlessly about the benefits of fruits and vegetables versus the risks from pesticide residues; or about the benefits of breastfeeding versus the risks of chemical contaminants in breast milk. In each of these situations, the goals are clear: first, pursue the established benefits (eat the omega 3s, fruits and vegetables, and breastfeed); second, avoid the risks when you can (steer clear of high-mercury fish, buy organic fruits and vegetables, and avoid chemicals that can get into breastmilk when you can); third, let's stop wasting our time debating these pseudo-controversies, and instead let's work for public policy changes that will reduce pollution in our environment, so we don't have to worry about nasty stuff in our food.

For some resources on which fish are low in mercury, check here. A nice overview of the Omega-3 issue for pregnant women is here. For those interested in the scientific issues, the best in-depth article (in my opinion) is here. Check it out and make up your own mind!

Clearing the Air: Walgreens Pulls Worrisome Air Fresheners from the Shelves

2007-09-20T16:56:30Z

It was nice to wake up to some good news this morning. Walgreens took a look at our test results that showed diethyl phthalate (DEP) in some of their air freshener products, and moved fast to do the right thing. They pulled the worrisome products from their shelves, commissioned additional tests to cross-check our results and look at their product line, and pledged to reformulate the products to get rid of unnecessary phthalates. Kudos to Walgreens for helping to clear the air.

The action from Walgreens is especially important because their products had some of the highest levels of phthalate. But we're still hoping that other companies will take a careful look at their product lines and do what they can to eliminate worrisome chemicals and also to inform consumers. We are also willing to look at independent testing data from the companies and update our website so that consumers have up-do-date information on these products.

This isn't really just about air fresheners, you know. The real issue here is that hazardous chemicals and endocrine disruptors can be in a wide range of consumer products, and the government has little authority or inclination to do anything about it. I find it distressing when patients or friends ask me about whether it's "safe" to use a certain product during pregnancy, or when they have a child in the home, and I have to respond "I have no idea". That's because most consumer products don't have to list ingredients, or even get tested for safety.

Phthalates are a particular concern because there's evidence that current exposure levels in the general population may not be safe. Research studies have found that some people have more phthalates in their bodies than others - maybe because of the consumer products they use in their home - and those people are more likely to have abnormalities in their sperm DNA, or have babies with altered hormone levels, or have baby boys with subtle feminizing changes in their reproductive tract. That's not good, and is all the more reason why it's a good idea to look for ways to reduce the sum total of our exposure to these chemicals.

Air fresheners aren't the only source of phthalates out there. They may not be the biggest source of phthalates out there. But these problems have a way of adding up, so any reduction is a good thing in the big health equation.

See ya later, I'm off to pick a few things up at Walgreens!

Air Fresheners - How safe are they?

2007-09-19T17:23:30Z

I swear these things are everywhere. When I'm at the hospital, there's a can in every bathroom. The nurses and housekeeping staff spritz away in patient rooms, in the nurses' station, and in the hallways. When I go into people's homes there's often one plugged into the wall in the bathroom, another in the bedroom, and sometimes even one in the kitchen. When I get my car washed I need to remember to tell them not to spray the car, or else I get behind the wheel again and smell that tell-tale "floral fresh" scent.

I know some people like the smell, but personally it makes my throat tickle and my nose itch. The question is - is it a health threat?

I took a look at this issue recently, and found a few interesting things. First of all, there are no government requirements that air freshener products get tested for safety or that there is any public information available on their ingredients. So forget about figuring out whether there's anything nasty in the bottle by reading the label. Secondly, there's not much testing info out there from independent sources either.

We did find a European study done by their equivalent of Consumers Union. However the air fresheners industry sued them and got the study suppressed, so it is essentially contraband, and is mostly only reported indirectly by the European Commission. The European study tested 74 products, including sprays, plug-ins, gels, and things like incense and scented candles. They found lots of chemicals of concern. The highest levels of ultra-toxic chemicals like benzene were actually in the incense. However, the standard air fresheners contained benzene, formaldehyde, irritants, allergens...and a chemical called DEP.

DEP stands for diethyl phthalate (thal-ate). Phthalates are chemicals present in lots of consumer products because they are handy for lots of things. They help paint and nailpolish spread smoothly and not crack; they help vinyl toys stay soft and squishy; and they help scents in perfumes (and air fresheners) disperse more effectively and last longer. The only problem is that many phthalates interfere with hormones (especially testosterone), and have been shown to alter normal reproductive development. Since these chemicals are easily inhaled and also absorbed through the skin, and they may affect the normal development of babies, it's a real concern that they're in consumer products.

Just recently, we did some independent testing of air fresheners - a limited study of only 14 products, just to get a glimpse of whether phthalates are even in these things. We found 'em. 12 out of the 14 products had detectable phthalates, and a few products had quite a lot. We found four major phthalates in these products, including one that's listed by California as "known to cause birth defects and reproductive harm". But the major phthalate we found was - you guessed it - DEP.

This new finding has stirred up an interesting scientific debate that now has some fairly significant policy implications. It turns out that DEP doesn't look too bad if you focus on the rat studies. It has some effects on the liver, but doesn't seem to affect reproductive development in rats. The industry points to this information as evidence that there's no problem. However, there are multiple human studies that show something different. Researchers from Harvard have published two studies linking DEP with abnormalities in sperm DNA, a study from the University of Rochester reports subtle genital alterations in baby boys with higher exposures to DEP in the womb, and a Danish study reports alterations in sex hormone levels in 3 month old babies whose mothers had higher levels of DEP in their breast milk. Maybe those moms were using air fresheners - who knows?

Anyway, in my opinion, this falls squarely in the "right-to-know" arena. Consumers may feel free to not worry and just keep on spritzing away. On the other hand, there may be a real issue here and the government certainly isn't doing anything about it. So it's your call: reach for the can, or just open the window?

Preparing for Global Warming

2007-09-12T23:02:50Z

I just spent the last two days at a meeting of the Institute of Medicine on "Climate and Human Health". The setting was nice - San Francisco's Presidio National Park - but the topic was disturbing. Here's the gist:

Nobody's arguing anymore about whether global warming's happening. Even the federal government people are saying this is serious.
The health effects are going to be complex and hard to deal with. Speakers discussed heat waves, extreme weather events such as hurricanes and floods, infectious disease spread, worsening air quality, worsening pollen, and even worsening poison ivy.
Our health system isn't prepared for this. The health agency representatives are still struggling to get their heads around what to do, and they really don't yet have a plan.

Yet I emerged from the meeting fairly optimistic. The fact that scientists and high-level government officials are getting together to even talk about this stuff means that there has been movement. Just a year ago, almost nobody was talking about the effects that global warming will have on our health. Now it's the topic of many major meetings, and lots of smart people are seriously working to figure this out.

Most of the speakers referred to the Intergovernmental Panel on Climate Change's (IPCC's) most recent assessment of human health effects. It's an interesting read, and it's here. The IPCC is pushing for increased "adaptive capacity". That doesn't mean that we shouldn't do everything in our power to cut our emissions of greenhouse gases. It does mean that no matter what we do to our emissions, we're still going to be hit with some serious climate disruption.

So the new climate strategy is twofold: cut our emissions ASAP to minimize the damage, and at the same time, prepare for some nasty times ahead.

Hey, I live in San Francisco so I have an emergency kit in case of earthquakes. I guess people in the rest of the country need to catch on and put one together as well.

Chemical Toxicity Testing

2007-09-09T21:55:22Z

A couple of months ago, a scientific panel from the National Academy of Sciences (NAS) released a report on the future of toxicity testing. The summary of the report, which can be found here, outlined a new approach to figuring out if chemicals in our environment are toxic.

As a member of the NAS panel, I spent a couple of years meeting and deliberating on this issue with about 20 of my scientist colleagues. It was a really tough process, both because we were trying to reach agreement despite many differences of opinion, and because the problem itself is so difficult.

Most people agree that if industrial chemicals or pesticides are going to be released into the environment or put into consumer products, they should be tested to make sure they're not toxic to human health or ecosystems. Testing includes checking whether the chemical causes acute or chronic effects, including cancer, neurological toxicity, and reproductive abnormalities. Traditionally, most of this testing has been done on laboratory animals, primarily rats.

In reality, the system in the U.S. is incredibly inconsistent across chemical categories:

Drugs are tested in depth in both animal studies and human clinical trials (yet "nasties" still slip by due to problems with the FDA system).
Pesticides undergo a standardized set of animal toxicity tests that take years to do and cost the manufacturers millions of dollars per chemical, but these tests still miss many chronic or subtle health effects. There's a great article that reviews many of these issues here.
Industrial chemicals basically don't get tested prior to going on the market. Instead, manufacturers simply need to inform EPA that they are planning to manufacture the chemical. If EPA wants the chemical tested, they either have to ask the company to test it voluntarily, or do an onerous rulemaking that requires testing - something they almost never do. The Government Accountability Office critique of industrial chemical testing in the U.S. is here.

So we're facing some important questions today. It's ridiculous that there are such discrepancies in chemical testing, but what model do we use? The NAS report offered four main goals for a chemical testing program (I'm paraphrasing below):

Breadth - Allows screening of the thousands of chemicals that enter the market each year, and the tens of thousands of ones that are already out there.
Depth - Gives us enough information about the range of toxic effects and doses that it's possible to use the data for regulatory decisions.
Preservation - Reduces animal testing to the extent feasible.
Efficiency - Rapidly obtains information without costing industry or the taxpayers impossible amounts of money.

The upshot of the Committee's deliberations was a proposal to make maximum use of the new tools on the horizon for toxicity testing. For example, there are new rapid tests in cell systems to show what these chemicals do to key enzyme systems, screens for hormonal activity, and genomic approaches to see what genes are turned on or off by different chemicals. These approaches are fundamentally different than current toxicity testing because they don't require a focus on 'endpoints' (such as cancer, birth defects, liver toxicity, or death), but instead focus on 'toxicity pathways'. An example of a toxicity pathway could include alterations of estrogen levels, or increases in markers of inflammation. Some day, we should be able to predict what types of nasty effects are likely if certain toxicity pathways are disturbed.

Meanwhile, as these new approaches are tested, they will offer us signals - yellow flags or red flags - that can help us make some precautionary decisions. Let's hope that happens soon enough.