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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
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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
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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.
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Solvents and other neurotoxic chemicals
Small exposures can have a big effect on the developing brain
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Two Ways to Make Hormones
Phthalates, Bisphenol A, Perfluorinated Compounds, Cadmium, DDT, Dioxin
Estrogen, Testosterone, Insulin, Progesterone, Thyroxine and others
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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
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Preventing Exposure to Chemical Carcinogens
Dick Clapp
B.U. School of Public Health
and U. Mass.- Lowell
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Current Mechanistic Understanding
Source: Hanahan D and Weinberg R. The Hallmarks of Cancer. Cell 2000;100:57-70
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Current Mechanistic Understanding
Source: Hanahan D and Weinberg R. The Hallmarks of Cancer. Cell 2000;100:57-70
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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/
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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
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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/.
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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/.
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Neurodevelopmental and neurodegenerative impacts of chemicals
Ted Schettler MD, MPH
Science and Environmental Health Network
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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
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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
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Additional neurodevelopmental hazards
• Methylmercury
• Polychlorinated biphenyls (PCBs)
• Pesticides
• Brominated flame retardants
• Perchlorate
• Organic solvents (in addition to ethanol)
• Arsenic, manganese
• Etc.
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Grandjean, Lancet, 2006
Developmental neurotoxicity of industrial chemicals
Lead
Methylmercury
Arsenic
PCBs
Solvents
Pesticides
Manganese
Fluoride
Perchlorate
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Chemicals increasing the risk of neurodegenerative disease
• Parkinson’s disease (Parkinsonism)
– Lead, manganese
– Pesticides
– Solvents
– PCBs
• Cognitive decline, Alzheimer’s disease
– Lead
– Some pesticides
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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.
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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
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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
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Multiple
Factors
Interact to
Influence
Health
&
Disease
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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”
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Federal Legislative Reform Efforts
Rachel Gibson, JD, MPP
Chemicals Policy Director
Health Care Without Harm
www.saferchemicals.org
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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.
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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
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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
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Questions ?
Charlotte Brody, RN, Safer Chemicals Healthy [email protected]
Richard Clapp, DSc, MPH, Boston University School of Public [email protected]
Ted Schettler, MD, MPH, Science and Environmental Health [email protected]
Rachel Gibson, JD,MPP, Health Care Without [email protected]
Special thanks to HCWH & Practice Greenhealth for making this webinar possible!
www.practicegreenhealth.org