What does Chemical Contamination Cost Health Care?

New report details how to reduce disease and save billions by overhauling the U.S. chemical management system

1/28/10

Presented by

Charlotte Brody, RN, Safer Chemicals Healthy Families

Richard Clapp, DSc, MPH, Boston University School of Public Health

Ted Schettler, MD, MPH, Science and Environmental Health Network

Moderated by

Gary Cohen, Health Care Without HarmRachel Gibson, Health Care Without Harm

Cancer

Learning and Developmental Disabilities

Parkinson’s and Alzheimer’s Disease

Reproductive Health and Fertility Problems

Asthma

A review of more than 1200 studies from the peer-reviewed literature

Could have included diabetes, obesity, immune disorders, cardiovascular disease

Formaldehyde:A grandfathered

chemical

25% of homes in Arizona had formaldehyde levels above recommended exposure levels.

Katrina trailers were made with plywood with formaldehyde levels that are illegal in Japan and the European Union.

Solvents and other neurotoxic chemicals

Small exposures can have a big effect on the developing brain

Two Ways to Make Hormones

Phthalates, Bisphenol A, Perfluorinated Compounds, Cadmium, DDT, Dioxin

Estrogen, Testosterone, Insulin, Progesterone, Thyroxine and others

What Part of Our Chronic Disease Problem Comes From Chemicals?

1% of chronic disease*3% of developmental disabilities**5% of childhood cancer***10% of diabetes, Parkinson’s Disease and

neurodevelopmental disabilities****10% of children’s neurobehavioral disorders***30% of childhood asthma***

* European Commission ** National Research Council *** Mt. Sinai School of Medicine Center for Children’s Health and the Environment **** Environment Canada

Preventing Exposure to Chemical Carcinogens

Dick Clapp

B.U. School of Public Health

and U. Mass.- Lowell

Current Mechanistic Understanding

Source: Hanahan D and Weinberg R. The Hallmarks of Cancer. Cell 2000;100:57-70

Current Mechanistic Understanding

Source: Hanahan D and Weinberg R. The Hallmarks of Cancer. Cell 2000;100:57-70

Total agents evaluated over 935

Carcinogenic to humans 108

Probably carcinogenic to humans 66

Possibly carcinogenic to humans 248

Not classifiable 515

Probably not carcinogenic to humans 1

International Agency for

Research on Cancer (IARC)

Evaluations of agents, mixtures, and exposures (as of Jan., 2010)

Source: International Agency for Research on Cancer. http://www-cie.iarc.fr/

IARC: Examples of agents classified as human carcinogens (not necessarily found in occupational settings)

• Benzene - in vehicle exhaust, cigarette smoke, somepesticides, around refineries

• Dioxin - production or combustion of chlorinated plastics, preservatives

• Formaldehyde - in resins and common household materials and products

• Vinyl chloride - in polyvinyl resins and products

Childhood Leukemias: Documented Links

• Benzene [Strong]

• Chlorinated solvents [Good]

• Metal dusts [Good]

• Specific Pesticides [Good]

• Trichloroethylene (TCE) [Good]

Source: Solomon G, Schettler T, Janssen S. “CHE Toxicant and Disease Database.” Accessed 3-

22-06: http://database.healthandenvironment.org/.

Childhood Brain Cancer: Documented Links

• Dichlorvos [Good]

• Lindane [Good]

• Solvents [Good]

Source: Solomon G, Schettler T, Janssen S. “CHE Toxicant and Disease Database.” Accessed 3-

22-06: http://database.healthandenvironment.org/.

Neurodevelopmental and neurodegenerative impacts of chemicals

Ted Schettler MD, MPH

Science and Environmental Health Network

Vulnerability of the developing brain

• A highly orchestrated sequence of events

• Cell division, migration, differentiation, synapse formation, myelination, synapse pruning

• Each process can be disrupted by environmental agents with long-term, downstream effects

Long-recognized hazards

• Alcohol – hyperactivity, cognitive deficits

• Nicotine – IQ deficit, learning and attention deficits; includes environmental tobacco smoke (LBW, intrauterine growth retardation)

• Lead – impaired IQ, learning, attention; hyperactivity, impulsiveness, aggression; failure to complete school, trouble with the law

Additional neurodevelopmental hazards

• Methylmercury

• Polychlorinated biphenyls (PCBs)

• Pesticides

• Brominated flame retardants

• Perchlorate

• Organic solvents (in addition to ethanol)

• Arsenic, manganese

• Etc.

Grandjean, Lancet, 2006

Developmental neurotoxicity of industrial chemicals

Lead

Methylmercury

Arsenic

PCBs

Solvents

Pesticides

Manganese

Fluoride

Perchlorate

Chemicals increasing the risk of neurodegenerative disease

• Parkinson’s disease (Parkinsonism)

– Lead, manganese

– Pesticides

– Solvents

– PCBs

• Cognitive decline, Alzheimer’s disease

– Lead

– Some pesticides

Lead

Cumulative occupational exposure• ↑ cognitive impairment Shih 2007

• 2x risk Parkinson’s Coon 2006

Cumulative community exposure

• ↑cognitive impairment Shih 2006

• Up to 15 years cognitive aging comparing highest to lowest quartiles Weisskopf 2004

Animal studies of early life exposure• late-life Alzheimer’s markers Basha 2005, Lahiri 2007.

Pesticides• Parkinson’s Disease

– 24/31 human studies show ↑ risks for PD. (OR 1.6-7) Brown 2006

– Animals - Combinations of maneb and paraquat; prenatal exposure “primes” the brain, increasing adult susceptibility Cory-Slechta 2005

• Cognitive decline/dementia– Occupational exposure associated with impairment of attention,

memory, 2x risk of developing Alzheimer’s disease Baldi 2003, 2001

• Insulin Resistance, metabolic syndrome Lee 2006, 2007, 2007

– Some persistent pesticides show strong dose-response relation toinsulin resistance and metabolic syndrome.

– Diabetes, features of the metabolic syndrome are themselves risk factors for cognitive decline, dementia

Conclusions

• Developing and aging brain are susceptible to adverse impacts of diverse environmental chemicals

• Exposures across the life-span can increase the risk of neurodegenerative disease later in life

• Early life exposures can uniquely “prime” the brain, increasing vulnerability

• Current regulations fail to address these realities; No Safety Testing Requirements

Multiple

Factors

Interact to

Influence

Health

&

Disease

Dick ClappB.U. School of Public Health

and U. Mass.- Lowell

Problems with cost analysis

• Multifactorial diseases not easily attributed wholly to chemicals

– Endless arguments about attributable fraction

• Cost-benefit analyses of childhood illnesses require “pricing the priceless”

Federal Legislative Reform Efforts

Rachel Gibson, JD, MPP

Chemicals Policy Director

Health Care Without Harm

rgibson@hcwh.org

www.saferchemicals.org

Toxic Substances Control Act

• Toxic Substances Control Act (TSCA) does not:– Require adequate testing of chemicals;*– Regulate known hazards;**– Provide incentives for safer alternatives; or– Allow sufficient public access to chemical info.***

• Calls for change by industry, government, health professionals

• Reform of TSCA is inevitable

* “Chemical Hazard Data Availability Study: What Do We Really Know About the Safety of High Production Volume Chemicals?” U.S. EPA, April 1998, http:/www.epa.gov/chemrtk/pubs/general/hazchem.pdf.

** “Chemical Regulation: Options Exist to Improve EPA’s Ability to Assess Health Risks and Manage Its Chemical Review Program,” GAO-05-458, U.S. Government Accounting Office, June 2005, http:/www.gao.gov/new.items/d05458.pdf.

*** “Chemical Regulation: Options for Enhancing the Effectiveness of the Toxic Substances Control Act,” GAO-09-428T, U.S. Government Accounting Office, February 2009, http:/www.gao.gov/new.items/d09428t.pdf.

Why Should Health Care Care?

• Largest purchaser of chemicals and chemical products

• Patient and worker exposure to chemicals

• Burden on health care sector to avoid potentially hazardous chemicals

Health Care Engagement

• Sign letter to Congress by February 19

• Speak to legislative offices in D.C.

• Serve as spokesperson for health care sector on issue

For more information:

Rachel Gibson, Health Care Without Harm

rgibson@hcwh.org

Questions ?

Charlotte Brody, RN, Safer Chemicals Healthy Familiesebrody@saferchemicals.org

Richard Clapp, DSc, MPH, Boston University School of Public Healthrichard.clapp@gmail.com

Ted Schettler, MD, MPH, Science and Environmental Health Networktschettler@igc.org

Rachel Gibson, JD,MPP, Health Care Without Harmrgibson@hcwh.org

Special thanks to HCWH & Practice Greenhealth for making this webinar possible!

www.practicegreenhealth.org