1

Environmental Epidemiology of the Great Lakes Basin

Industrial Pollution and Human Health

August 1999

2

Overview

1. Pollutants

2. Local examples, reaction of public health officials

3. Medical literature: health effects

4. Economics and politics

3

1968

• University of Waterloo

• Dr.Bryce Kendrick, Professor of Botany

• University of Toronto

• Dr. Don Chant, Professor of Zoology

• Pollution Probe

4

1989

• Dr. Paul Connett, Professor of Chemistry St. Lawrence University, New York State

• dioxin chemist

• Work on Waste USA

5

500 articles on Environmental toxics , 1992 - 1998

• Canadian Medical Association Journal

• JAMA

• New England Journal of Medicine

• British Medical Journal

• The Lancet

• (others)

6

500 Journal articles on Toxics1992 - 1998

0102030405060708090

100

1992 1993 1994 1995 1996 1997 1998

Year

Number of articlesappearing 1992 -1998

7

Medline computer search:dioxins and human health

1995 -Dec 1998• 217 articles in many other journals: e.g.

• J. Epidemiology and Community Health

• Early Human Development

• Environmental Health Perspectives

• Chemosphere

• Am J of Epidemiology

8

Robert Fletcher, M.D.internist, clinical epidemiologist

• Prof, Harvard Medical School

• Founding editor , Journal of General Internal Medicine

• Editor, Annals of Internal Medicine

• author, Clinical Epidemiology

9

Robert Fletcher, II

• What is your greatest concern?

• “Destruction of the good earth by toxins or nuclear waste.” (or simply too many people)

The Lancet, Lifeline, Jan 2, l999

10

“Toxics”

I. Any industrial pollutants

II. Chlorinated Organic chemicals, COC’s

11

Environmental Epidemiology of the Great Lakes

Human Health Effects of Industrial Pollutants, Effluents and Toxics

November 1998 presentation, Oakville Ontario, to:

12

Canadian Association of Physicians for the Environment

C.A.P.E.

13

Health Canada, l997

“State of Knowledge Report

on Environmental Contaminants

and Human Health

in the

Great Lakes Basin”

• 300 pages

14

Arctic Pollution Issues

• Arctic Pollution Issues, A State of the Arctic Environment Report, Arctic Monitoring and Assessment Program, Oslo, l997

• Highlights of the Canadian Arctic Contaminants Assessment Report, a community reference manual, Northern Contaminants Program, Ottawa, l997

15

Where do contaminants goin North America?

• Great Lakes Basin

• St. Lawrence River

• Rocky Mountains

• Arctic

16

Cdn J of Public HealthSupplement, May/June l998

• What on Earth? A National Symposium on Environmental Contaminants and the Implications for Child Health (selected papers)

• Canadian Institute of Child Health

• May l997, Ottawa

17

What are the causes of illnesses?

1. Genes

2. Environmental factors

18

McGinnis & Foege, DHSSJAMA, Nov 10, l993

“Actual Causes of Death in U.S.”

2 components to the cause of illness:

1. Genes

2. Environmental factors

19

Genetic factors in illness

• Genetic resistance/susceptibility

• some individuals more susceptible than others

• e. g. cancer:

tumor suppressor genes

cancer families

20

Environmental factors in illness(McGinnis, JAMA, 1993)

1. Smoking

2. Animal fat

3. Alcohol

4.infectious disease

5. TOXICS exposure6. Automobiles

7. Firearms

8.drugs

21

Toxics exposure in theGreat Lakes Basin?

• How many people?

36 million

22

How many chemicals are in the Great Lakes?

800

sources: agricultural

industrial

municipal

23

How many chemicals

• 100,000

• 3,000 in high volume use

• 95% have incomplete health data• 43% have no health data (Bev Thorpe,1999)

• present in: dirty dozen: Epstein

24

What chemicals??What pollutants??

1. Organic chemicals:

a. non chlorinated:

methanol, ammonia

toluene, benzene, methyl ethyl ketone, ethylene glycol

25

2. Chlorinated/brominated organic chemicals, COC’s

“Persistent toxic substances”

“Persistent organic pollutants, POPs”

e.g. pcb’s, dioxins, furans

26

Dioxins

27

Barry Commoner2nd Citizens Conference on Dioxin, St. Louis,

Missouri, July, l994

• “Dioxin and dioxin-like substances represent the most perilous chemical threat to the health and biological integrity of human beings and the environment.”

28

WHO Tolerable Daily IntakeDioxin, Sept l998

• 1990: 10 picogram/kg for 2378 tet dioxin

• new epidemiologic data on effects on nervous and endocrine systems

• new TDI, tolerable daily intake

• 1 to 4 pg/kg

Medical Post,Sept 22, l998

29

Source of Daily Intake

Food

90%

30

Dioxin intake: Breast feeding

“In the Great Lakes Basin exposure to TCDD during Breast feeding exceeds the established TDI for this contaminant.”

• Cdn J of Public Health, May/June l997,

from Haines et al, Environ Res, 1998

31

Canadian Breast milk survey

• Twenty five Years of Surveillance for

Contaminants in Human Breast Milk

• A. G Craan, D. A. Haines, Great Lakes Health Effects Program, Health Canada,

• Archives of Environ Contam and Toxicology. 35, 702 - 710 (1998)

32

Misleading?

• “There are indications that dioxin and furan levels in breast milk are decreasing (see Table 4 of the Craan and Haines article.) Further monitoring over the next ten years will be needed to confirm this trend.”

• D. Haines, personal communication, January 29, 1999

33

Daily Intake of Dioxin/furan from Breast milk ( pg/kg bw/day)

010

2030

4050

607080

90100

1967 1970 1975 1982 1986 1992

Dioxins + Furans inTEQs

34

Concentrations of dioxins and furans in Canadian human milk

pg/Kg Whole milk

0

100

200

300

400

500

600

700

800

900

1982 1986 1992

2,3,7,8 TCDDTEQ D + F

35

1992 estimated daily intake of dioxin from breast milk/formula

pg TEQ/Kg body wgt/day

0

10

20

30

40

50

60

1992 WHO TDI 1998

Breast milkformula

36

WHO TDI Dioxin 19981 - 4 (2.5) pg/kg body wgt/day

• 5 - 6 month Canadian infant taking in 750 ml milk daily:

• Breast milk: 25 times TDI

• formula: 5 times

37

Misleading?

• “Table 6-5 shows that the mean levels ofd total PCDDs/PCDFs in adipose tissue of Canadians are comparable to those reported for other countries.” Page 65,

• State of Knowledge Report on Environmental Contaminants and Human Health in the Great Lakes Basin , Health Canada, 1997

38

Table 6-5

• Ryan, 1985, Canadian samples collected in 1976 throughout Canada , post mortem. U.S. samples collected l983-84,NY state

• Schecter, 1986, Vietnam. Southern areas were sprayed with Agent Orange while northern areas were not.

• 1029, 985, 1577, 147 respectively. (see also Sweden, Japan, East Germany,

39

Mean levels of PCDDs and PCDFs in Human Adipose Tissue

0200400600800

1000120014001600

Swed

en

Can

ada

Japa

n

Sout

hV

ietn

am

Total PCDDsTotal PCDFs

40

countries

• Sweden, 1986, Dsgren (some exposed)

• New York State, USA , Ryan, 1983 (MVA)

• Canada, Ryan, 1976, &Teschke, 1992 ( “ )

• Japan, 1986, Ono

• North Vietnam, Schecter, 1986 (no AO)

• South Vietnam, “ (Agent Orange)

• Fed Rep Germany, Rappe, 1987 (exposed)

41

“comparable”

• Levels in Canadians/ NY State residents sampled from accidental death (“unexposed”) victims

• comparable to:

• countries where residents were exposed to dioxins

42

What pollutants? II

2. Heavy Metals:

Mercury, lead, arsenic, cadmium

Copper, zinc

(No discussion of health effects)

43

What pollutants? III

3. Classic Air Pollutants

• Particulates (PM 10, PM 50)

• Ozone

• Acid Gases (Sox, Nox, HCl)

• CO

44

What pollutants? IV

4. CO2

Global Warming

45

Sources

• Industrial processes, e.g. petrochemical industry e.g. PVC

• coal fired power plants• automobile engines, (gas, diesel)• pulp and paper industry• waste incineration (3)• cement kilns• hazardous waste landfilling, dumping

46

Municipal Solid Waste: backyard barrel burning

• PVC plastic

• significant source of dioxin

47

Incineration of Medical Waste, I

• U. S. E. P. A.

• 3rd largest source of Dioxin

• major source of Mercury

• North American environment

48

Incineration of hospital/medical waste, II

• Lynn R. Goldman, MD, JAMA, Aug 12,98

• EPA: assistant administrator for toxic substances

• 2% of hospital waste needs incineration

• 75% -100% actual

49

What is the Current toxic load entering the Great Lakes Basin?

• Canadian NPRI, (1993)

• U. S. EPA TRI , (l990)

• 1000 tonnes per week

• US GAO: 5% of total:

• 20,000 tonnes per week

50

What is the Current toxic load entering the Great Lakes Basin?

Great Lakes United, 1997

2500 tonnes per week

(100 truck loads)

51

Provincial Auditor of Ontario1996

• 1200 tonnes in Province of Ontario /week

(1000 tonnes into the air)

52

NAFTA: CECToxic Load in North America

1998

• 1 million tonnes per year

53

54

What are (or could be) the Human Health Effects

of Toxics?

1. Proven

2. Speculative/unproven

55

Public health Officials

Concerned citizens

ask questions

about hazardous chemicals

in their communities

56

Public health officials offerReassurance

The following are some local, provincial, national and international

examples

57

Bay of Quinte Hazardous Waste Sites

1. Trenton Norampac: Dombind

2. Aikens Road landfill

3. Zwick’s Island Park landfill

4. Meyer’s Pier coal gasification site, pah’s

5. Bakelite plant, phenols

6. Deloro mines: arsenic/radioactivity

7. Rednersville Road , TCE

8. Richmond municipal landfill site, Napanee

58

Other Hazardous Waste Sites

• West Lincoln, Ontario (incinerator)

• East Liverpool, Ohio ( “ )

• Times Beach, Missouri (dioxin in waste oil dust suppressant)

• Sydney Mines, Cape Breton Island (PAH’s)

59

#1

Rednersville, Ontario

60

Rednersville, Ontario, 1990

• Illegal hazardous waste site

• 200 barrels of VOC’s: TCE, benzene

• 1973-1988: 15 years

• 16 (25) families: contaminated water

• compare Woburn, Mass case

• MoH Health Study

61

Woburn, Massachusetts1970 - 1990

• Drinking water contamination with TCE

• 2 local plants: W.R.Grace, Beatrice Foods

• 12 children died of leukemia (‘70’s)

• civil action by citizens,

• EPA action, 1990

• $70,000,000 liability, cleanup operation

• Civil Action, Jonathan Harr,

62

Rednersville Health Study, 1990

• “no evidence of human health effects”.

63

#2

Zwick’s Island landfill, Meier’s Pier

Belleville, Ontario

64

Zwick’s Island Park, Meyers PierBelleville, l998

• Municipal/hazardous waste landfill

• Creasy engineering Report

• leaking : PAH’s (benzo (a) pyrene),

VOC’s (chloroform)

• compare NY State and Eurohazcon studies

• Municipal Health study: risk assessment shows elevated cancer risk at Meier’s Pier

65

• NY State ATSDR June l998: cancer

• Eurohazcon study, Dolk,1998: congenital

defects (The Lancet)

66

Zwick’s Island/Meyer’s Pier Creasy (Engineering), 1998

• Belleville City Council says reports show the following compounds in the landfill sites:

• sodium chloride, “table salt” (Belleville Intelligencer)

• “ammonia” (smelling salts)

(Community Press, Dec.24, 98)

67

Zwick’s Island/Meyer’s Pier Health Study, 1998

“These places are not unsafe for people.”

City Administrator,

Belleville Intelligencer, Nov.3,98

68

#3

Dombind, Eastern Ontario

69

Dombind, 1993 - 98 Hastings/Northumberland/Peterborough

Trent River-Moira watershed

• Dust suppressant in 90 townships

• Domtar spent black liquor

• 50 million litres/yr (6100 tanker trucks)

• Dioxins, furans, metals, phenols

• compare Times Beach, Missouri

• MoH Health Study (Hukowich):

70

1994, Times Beach, Missouri

• 2nd Citizen’s Conference on Dioxin

• St. Louis/Times Beach• 1970’s

• dioxin-contaminated waste oil as

dust suppressant on roads

71

Dombind Health Study, 1998

• “On the very narrow issue of whether the use of Dombind constitutes a health hazard within the Health Protection and Promotion Act, I have concluded that it does not.”

Alex Hukowich, MOH, Peterborough

Belleville Intelligencer, Oct 21, l998

72

Norampac Inc, Trenton

• Dombind disposal problem

• consideration underway (1999) for hazardous waste incinerator construction as an alternative to Dombind method of disposal of pulp liquor

73

#4

Richmond landfill site, Napanee, Ont

74

Richmond (Napanee) landfill site

• 2 million tonnes existing• Canadian Waste Services• application for 750,000 more annual tonnes• leachate flow into:Marysville,Sucker Creek• thence into Bay of Quinte• Committee of Concerned Residents• Paul Finkle, Stephen Geneja, Residents• community press, April 2, 1999

75

#5

Kingston landfill site

76

Kingston landfill case, 1999

• Janet Fletcher

• private prosecution, federal Fisheries Act

• joined eventually by MoE who initially declined the opportunity

• guilty

• fine

• see 1999 press file

77

#6

Arsenic leakage into Moira River Deloro, Ontario

78

Deloro, Ontario

• Arsenic leakage into river at Deloro

• 100,000 tonnes of arsenic tailings

• 10 tonnes per yr leak into Moira R

• Deloro human health Risk study,1999: no human health effects

• Moira River Impact study, 1999, screening human health risk assessment under way

79

Deloro hazardous waste site

• Spring, 1999 MoE health study

• urine samples

• control urines: ?neighbouring community

• number of people: ?200

• MoE toxicologist:

• likelihood of stat sign findings: low

• “crackerjack teams of experts in Toronto”

80

#7

Peterborough,Ontario

81

Peterborough, Ontario

• Feasibility hearings for municipal incinerator construction, April 1999

82

#8

Cornwall, Ontario

Material resources recovery unit

83

Cornwall, Ontariomaterial resources recovery unit

• Public hearings, attended by Ellen and Paul Connett, August 1999

• application for permit to burn 30,000 ppm PCB’s, current permitted for 50 ppm

• Cornwall/Massena area already heavily contaminated with PCB’s

84

Cornwall hazardous waste incinerator

• October 1998, began operation

• PCB’s from fluorescent light ballast

• In the new permit they also want to burn:

• pharmaceuticals, chloroflurocarbons, electrical equipment, poisonous and reactive gasses, “controlled substances” and waste oils.

85

Response of Medical Officer of Health

• Dr. Bourdeau: 5 county Eastern Ontario Health Unit, quoted the: 1996 Harvard Report on Cancer Prevention (R. Clapp) to explain cancers:

• 30% from smoking, 30% from obesity and fat and lack of exercise

• and 2% from environmental sources.

• (noted lower male:female birth ratio in Cornwall in passing)

86

#9

West Lincoln, Ontario

failed proposal of 1980’s

87

OWMC hazardous waste facilityWest Lincoln, Ontario, 1980’s

• Hazardous waste incinerator

• 60,000 tonnes per year

• Joint Board Hearings, Oakville Ontario

• 1991 - 1993

• Health Risk Assessment

88

West Lincoln Risk Assessment

• Negligible Cancer risks

• No Non Cancer health effects

• “No evidence of significant health effects”

89

Examples from elsewhere in Canada and United States

90

# 1

Sydney Tar Ponds, Nova Scotia

91

Sydney Mines, Cape Breton, NSTar ponds, 1995

• CMAJ, March l5, l995

• cokes ovens, steel plants

• PAH’s in tar ponds (700,000 tonnes sediment)

• Cancer mortality: 25% higher in women, 49% higher in men than provincial average

• Provincial Epidemiologist:

92

Sydney tar ponds

• Lifestyle factors, namely smoking and poor diet, were said to be responsible by public health officials

93

#2

East Liverpool, Ohio

hazardous waste incinerator

94

WTI hazardous waste incineratorEast Liverpool, Ohio, 1997

• Hazardous waste incinerator

• 200 miles south of Oakville

• 60,000 to 170,000 tonnes per year

• EPA hearings, East Liverpool, 1997

• Dioxin output ?????? (UNKNOWN)

• Health Risk Assessment, 3500 pages

95

East Liverpool Risk Assessment

• Negligible Cancer risk

• No additional Non Cancer health effects

• “No evidence of significant health effects”

96

Citizens ask questions about toxic substances in their

communities

• Public health officials

• 1. Epidemiology

2. Risk Assessment

97

“No evidence of human health risk.”

98

Hamilton, March 1999EverydayCarcinogens conference

• Dr. Richard Schabas

• head, cancer prevention, CCO

• keynote speaker

• did not address the issue of environmental carcinogens

• citizen delegation to CCO, July 1999, presentation made to Dr. Ken Shumak

99

Reassurance

Pattern of Denial ?

by public health authorities

100

Denial by developers

• Royal Group Technologies, Woodbridge• “plastic houses”• PVC interlocking panels for wall

construction• filled with cement• since 1996

101

Denial by developers, II

• Charlie Cray, Greenpeace, Chicago

• “PVC emits dioxin when it burns. It’s very toxic”

102

Denial by developers, III

• Gwain Cornish, senior VP and chemist

• Royal Group Technologies

• “The amount of dioxin emitted by burning PVC is negligible. Even mashed potatoes give off more toxins than PVC.”

Globe and Mail, Jan 23, l999

103

Medical literature

1992 - 1998

104

Non reassuringmedical literature

1. Limitations of Epidemiology and

Risk Assessment

2. Reports: changes in disease patterns

strong hints:

industrial chemicals are implicated

105

“More controversy, little clarification”…

• “The impact of low-level exposures on human health has proved difficult to investigate but refined environmental epidemiological methods and mechanistic studies are providing new insights…..Although environmental health risks are of low magnitude and difficult to prove, they may still pose …..

106

……….The LancetEnd of Year Review, Dec 1998

….an important public health problem if large numbers of people are exposed, and if certain populations are disproportionately exposed…..The need for better risk assessment and better education of the public regarding environmental risks is being recognized.”

Carrie Redlich, MD, Yale University

107

I. Cancer

108

Dr. Bernard Dixon, editor BMJ, June 11, l995

“Cancer is essentially a disease of genes which are triggered into mischief by external carcinogens such as chemicals and radiation.”

109

Epidemiology(has a problem)

Do

industrial effluents

cause

cancer?

110

Dr. Anthony Miller,U of T Epidemiology

JAMA Feb 9, l994

• “We must remember the long natural history of cancer, and that the full effect of exposures to carcinogens in early life may not be seen until those exposed reach advanced age.”

111

Dr. David KesslerU. S. FDA,

Joint Report of Pesticide Use, June l993

• “We know that children are overexposed, and we know that the chemicals are toxic. But when cancer or chronic neurological, immune or reproductive problems show up years later there will be no footprints left.”

112

CLASSIFICATION OF CANCERby Age

1. Childhood Cancer, < age l7, 19

2. Adult cancer

113

Childhood Cancer

• Dr. Anthony Miller

• CMAJ Dec l5, l994

• 1969 - 1988

• overall incidence: rose from 13 to 17 per 100,000

• 20% increase in 20 years

114

Canadian Childhood Cancer Control Program , I

Gibbons, Mao, Levy, Miller, CMAJ, Dec l5, l994

0

2

4

6

8

10

12

14

16

18

1969 1972 1975 1978 1981 1984 1987

No. of cases of cancerper 100,000 children,1969 - 1988

115

Canadian Childhood Cancer Control Program II,

Gibbons, Mao, Levy, Miller, CMAJ, Dec l5, l994

00.5

1

1.52

2.53

3.54

4.5

5

1969 1972 1975 1978 1981 1984 1987

No of cases ofchildhood leukemiaper 100,000, 1969 -1988

116

Childhood ALL

• Landrigan and Pui• NEJM Nov 9, l995• SEER data• from l973 to l991• increased from 2.7 to 3.3 cases per 100,000

children

• 20% increase in 20 years• causes: unknown, ? Environmental toxins

117

Childhood Brain Tumors

• Dr. Rutka, Neurosurgeon, HSC• Medical Post, September l5, l998• 1990: 60 • 1997: 100• Dr. John McLaughlan,U of T Epidemiology• “There is strong evidence that children who live in close

proximity to hydro transformers, nuclear power plants and industrial toxins are at greater risk of brain tumors.”

118

Parliamentary Assistant to the federal Minister of the Environment

• Paddy Torsney

• AAUW/CFWW Cross Border Conference

• October l998

• male: “25% increase”

• female: “42% increase”

in rates of Childhood Cancer

• ? Reference/source

119

“Childhood Cancer and Environmental Contaminants”

• Cdn J Public Health, June 1998

• Mary Mcbride, B.C. Cancer Control

Agency

• 185 references

120

Adult Cancer

121

Adult Cancers

• Common, increasing: lung, (bowel), breast, prostate.

• Uncommon, increasing:

1. NHL

2. Brain tumors

3. Melanoma

4. Testicular cancer

122

Common Cancers

123

Lung Cancer

Genes

124

Tumor suppressor genes

• Control cell reproduction

• Individuals/families who are:

genetically RESISTANT

“ SUSCEPTIBLE to cancer

125

Tumour suppressor genes:Normal vs. Mutations

0%10%20%30%40%50%60%70%80%90%

100%

resistant TO CANCER susceptible

MutantNormal

126

Lung Cancer

• Tang, (Smithville, USA)

• Lancet Oct 26, l996

• 4000 chemicals in Cigarette smoke

• Benzo (a) pyrene

• DNA damage to p53 tumor suppressor gene

127

Tang

(one) mechanism

by which

Toxics cause cancer

128

Benzo (a) pyrenein the Great Lakes Basin

• PAH (polyaromatic hydrocarbon)

• by product of petrochemical processes

• IJC, International Joint Commission

• 11 critical contaminants: pcb, dioxin, furan, ddt, toxaphene, mirex, dieldrin, hcb, methyl mercury, alkylated lead, benzo(a)pyrene

129

Bowel cancer:Chlorine and drinking water (I)

• Will King, OCTRF/Queen’s University

• Dec 6 , l995

• chlorinated water

• 10% increase in bowel (and bladder) cancer

• ?Trihalomethanes

130

Bowel cancer:chlorinated drinking water (II)

• Doyle, Univ of Minnesota

• Lancet, Aug 23, l997

• 28,000 post menopausal women in Iowa

• chlorinated drinking water

• increased colon cancer

131

Breast Cancer & industrial chemicals

• Dr. Devra Davis

• World Resources Institute

• JAMA, Feb 9, l994

• 1973 - 1987

• 19 % increase

• ? Environmental xenoestrogens

132

CCO graphBreast cancer incidence

• Rising

• on display at Everyday Carcinogens conf

• March 1999

133

Devra Davis: (cont’d)

• “There are critical periods in development, e.g. the first trimester of pregnancy and adolescence, when sensitivity to carcinogenesis is high. Timing of exposure to chemicals and radiation can be more important than dose.”

134

Breast cancer and chemicals:CON

• Stephen Safe, Ph.D, Texas A&M University• editorial, NEJM, Oct 30, l997• “chemophobia, the unreasonable fear of

chemicals”• “paparazzi science”

• 2 problems ??

135

Safe’s editorial

• Hunter ? Doubtful conclusions

• ?undeclared interests (CMA)

136

Breast Cancer and chemicals: CON

• Hunter, Organochlorines and the risk of breast cancer, NEJM, Oct 30, l997

• 240 women, case control study

• pcb, dde levels

• No difference on organochlorine levels

• (? Breast cancer group genetically susceptible)

137

Breast cancer & Breast feeding

• Moysich, Vena, SUNY Buffalo, l997

• women from Love Canal area, western NY

• organochlorine exposure

• breast feeding was a protective factor vs breast cancer: lower blood levels of DDE

• “The chief mechanism for eliminating organochlorides from the breast is lactation, which flushes them from the system.”

138

...Recipient of this toxic flush

…...Newborn breast feeding infant

139

Prostate Cancer

• Morrison, LCDC

• Cdn Journal of Public Health,

• July/Aug ‘96

• predicted tripling in rates over next 20 yrs

• “part of the increase may be due to chemicals in the environment ” ????

• no evidence

140

Prostate cancer, II

• Gallagher, Fleshner

• CMAJ, October 6, l998

• strong relationship to Dietary Fat intake

141

Uncommon Cancers(that are increasing)

* 1. NHL

2. Brain tumors

3. Melanoma

* 4. Testicular cancer

142

Non Hodgkin’s Lymphomas, I

• Adami et al, Sweden

• BMJ, June 10, l995

• 2 - 4% annual increase • in a number of countries

• ?role of u/v exposure

143

Non-Hodgkin’s Lymphomas, II

• Freedman

• BMJ May 17, l997

• mortality NOT associated with u/v exposure

• ? Unsuspected environmental agents

144

Non-Hodgkin’s Lymphomas, III

• Rothman, Cantor

• Lancet, July 26, l997

• occurrence of NHL related to PCB levels

• ?immunosuppression, with EBV susceptibility

145

Non Hodgkin’s Lymphomas

• 2 - 4 % annual increase

• Rothman, Cantor

• Lancet, July 26, l997

• occurrence of NHL related to PCB levels

146

Testicular cancer, I

• 2 - 4 % annual increase for last 25 years

• Scandinavia, Europe, North America

• Danish EPA, l995

• Canada, 2% annual increase ,

over 30 yrs,Weir, Jan 26,1999,CMAJ

147

Testicular cancer, II

• “It is a reasonable hypothesis that toxins acting during the early fetal development of the gonads are involved in the ….increase in the incidence of testicular germ cell cancer…..The likely culprits include DDT, PCBs, nonylphenol, bisphenols and vinclozolin.”

• L. Klotz, MD, CMAJ, Jan 26, 1999

148

Testicular cancer, III

• “Changes in male genitalia, such as the increasing incidence of testicular cancer in the U. S., could be like a canary in a mine shaft.”

• Harry Fisch, director, Male Reproductive Centre, Columbia Presbyterian Medical Centre, New York

Globe and Mail, Jan 26, l999

149

Adult Brain Cancer

• Workshop Group on Brain cancer

• CMAJ, March l5, l992

• DOUBLING of rate, 1969 - 1985

• age > 65

• occupational and non-occupational exposure to chemicals

150

Melanoma

• BMJ Jan 20, l996

• DOUBLING of rate in Southern Hemisphere

• chlorofluorocarbon release:

• ozone loss, increased u/v exposure

151

II. Non Cancer illnesses

152

Non-cancer illnesses

• 1. CardioRespiratory

• 2. Reproductive and Developmental

• 3. Neuropsychological

4. Endocrine

5. Immunological

153

1. CardioRespiratory

• Asthma

• Chronic lung disease

• Myocardial infarction

• 1800 deaths annually in Ontario from cardio-respiratory disease related to air pollutants (Eva Ligeti, Ontario government

Environment commissioner, 1998)

154

Classic Air Pollutants:

• Particulates (PM 10, PM 50)

• Ozone

• Acid Gases (Sox, Nox, HCl)

• CO

155

2. Reproduction and

Development

156

Environmental Estrogens“Xenoestrogens”

1. Chlorinated organic chemicals

2. APE’s (alpha phenyl ethoxylates), surfactants, detergents

3. Bisphenols (polycarbonate subunit)

4. phthalates (plasticizers)

157

2.Reproduction & Development

a. (Canadian) MEN1. declining sperm counts

2. declining male:female birth ratio

3. Increasing abnormalities of male sex organs (hypospadias)

4. Shrinking testicle size(Klotz, CMAJ,Jan99)

5. Increasing testicular cancer

158

Declining Sperm Counts, I

• Carlsen, Skakkebakk (Copenhagen)

• BMJ, l992

• metanalysis of 61 studies:

• 50 years, 1940 - 1990

• 40% reduction in sperm count

• coincidental introduction of COC’s into industrial production in 1940

159

Declining Sperm Counts, II

• French (Thibeault, Bujan

• British (Irvine, Sharp)

• American (Fisch)

• Scandinavian (Pajarinen)

160

Declining Sperm Counts, III

• Canadian study: Feb l998

• Health Canada/McMaster University

• 49,000 Canadian men

• 1984 - 1996, 11 centers

• 1.4 % reduction per year

161

Declining Sperm Counts, IV

• Swan (California)

• Lancet Nov 29, l997

• reanalysis of Carlsen’s meta analysis, l992

• USA: 1.5% reduction annually, 1938 - 90

• Europe: 3.1% reduction annually,l971- 90

162

?Declining Sperm Counts

• NIH

• ACDCP

• started study Nov l997

163

Male genital malformations: Hypospadias

• Paulozzi, (Pediatrics, 100, l997)

• Atlanta, l968 - 1992

• DOUBLING to 30 per 10,000 births

• similar increases documented in:

• US wide Birth defects monitoring program

• European/Scandinavian studies of l980’s

164

Declining male:female birth ratio I

• Usual ratio: 51.5% are male

106: 100• declines documented in:

• Davis & Gottlieb, JAMA April 1, l998

(European countries)• Patterson, Lancet Aug 10, l996 (Seveso)• Williams, Int’ J Epidem, l992 (incinerators)

165

Declining male:female birth ratio II

• Allan, Jarrell et al

• CMAJ Jan 1, l997

• Canada, 1930 - 1990

• after l970: 2.2 less male births/1000/year

• ovulation inductions drugs could NOT account for all of the reduction

166

2.Reproduction & Development

b. WOMEN

1. Shorter menstrual cycles

2. Threatened miscarriage

3. Endometriosis

4. Premature ovarian failure

167

Delay in Conception?

• Mendola, Buck

• Am J Epidemiology, Dec 2, l998

• New York State residents

• eating Lake Ontario fish for 7 yrs

• No significant delay in conception

• Menstrual cycle was 1.1 days shorter

168

Premature ovarian failure/menopause

• Cowan & Seifer

• Clinical Reproductive Medicine, 1997

• 7 causes of premature menopause

• “environmental dioxin”

169

2.Reproduction & Development

c. EMBRYO, FETUS AND NEONATE:

Birth cycle:

1. Ovary contamination

2. IUGR

3. Congenital birth defects

4. Increased gonadal intersex

5. Breast milk contamination

170

Soderstrom, Michigan State Medical Society

CMAJ, Oct 1, l998

• “The development of embryos of different species is a very similar thing, especially in the first few weeks. Whether it’s a human, a fish or a bird, it goes through much the same process. So if there’s an extensive problem

for (wildlife such as) fish and birds, and there certainly has been, there is no reason to think that there cannot be effects on humans.”

171

Preconceptual environment

• Jarrell

• CMAJ, April l5, l993

• ? 6 Canadian cities

• fluid in human ovarian follicles

• measurable levels of 5 organochlorines:

dde, pcb, hexachlorobenzene, chlordane, heptachlor

172

Fetal development

• Vivyan Howard

• University of Liverpool Fetal toxicopathology group

• 2nd Citizens Conference on Dioxin, l994

• IUGR as a conseqence of toxics exposure

173

Congenital Birth Defects I

• Lie, NEJM July 7, l994: cause of 2/3 of birth defects is unknown

• Rodgers, University of Kentucky, 1994: increased birth defects in Times Beach, Missouri after dioxin contamination

• U. S. IOM, Lancet June 8, l996: Agent Orange (dioxin) and Spina Bifida in children of Vietnam veterans

174

Congenital Birth Defects II

• Helen Dolk, London School of Hygiene

• Lancet, August 8, l998

• Eurohazcon study (hazardous waste sites)

• residents within 3 km of landfill

• 1.33 Odds Ratio : congenital anomalies

• NTD’s, cardiac septal defects, transposition of great arteries and veins

• statistically significant

175

Breast feeding, I

• Frank, Newman

• CMAJ, July 1993

• pcb’s and other toxics in breast milk

• “good evidence of subtle fetal and infant health effects resulting from prenatal (intrauterine) exposure”

176

Breast feeding, II

• WHO committee

• Lancet, BMJ, May l997

• 2 month old breast fed infant

• receives 17 times the TDI of pcb’s and dioxins from breast milk (50 times)

• breast feeding a “significant risk” ??

177

Breast feeding, III

• Craan & Haines, GHEP, Canada

• Arch Environ Contam Toxicol, l998. 35, 702-10

• Twenty five years of Surveillance for Contaminants in Human Breast Milk

• Canada: 6 surveys of human breast milk . 1967, 1970, 1975, 1982, 1986, 1992

178

Canadian Breast milk studies

• Summary: Persistent Environmental Contaminants and the Great Lakes Basin Population: An Exposure Assessment

• Health Canada, 1998

• Douglas Haines, GLHEP

179

Canadian Breast milk

A B C D E

• 1982: 889 95

• 1986: 562 60

• 1992: 522 56 12 2.5 25/5

• A . pg TEQ D+F/kg whole milk

• B/C Pg Teq D+F/kg body wgt/day daily intake, Breast milk/formula

• C. WHO TDI, l998 D. factor over WHO

180

3. Brain

• PCB’s and brain injury in:

• babies/children of fish-eating residents of:

Lake Michigan (Jacobson)

Lake Ontario (Daley)

• adults

St. Lawrence River (Mergler)

181

Human brain development:Lancet Oct 11, l997

• 20th week of gestation .

• number of new synapses (nerve cells and connections) being formed per second:

40,000

• Can toxic exposures interfere?

182

Neuropsychological, I

• Jacobson & Jacobson

• NEJM Sept 12, l996

• followup of original cohort, now age 11

• pcb’s in utero from contaminated Lake Michigan fish eaten during pregnancy

• abnormal body wgt/head circ at birth

• 6 point IQ reduction at age 11

183

Neuropsychological II

• Helen Daly

• SUNY Oswego NY

• mothers ate pcb-contaminated Lake Ontario fish during pregnancy

• newborn babies

• “abnormal psychological reactions”

• (No abnormal body weights/head circ)

184

Neuropsychological , III

• Kosatsky, Mergler 1997

• Gt. Lakes/St. Lawrence Health Conference

• Lac St. Louis, Lac St. Francois

• deficits in attention, concentration and cognitive intellectual function in fish eaters

• pcb levels in fish eaters were “well within Health Canada guidelines”

185

4. Immunologic Effects

186

Immunologic Effects, I

• McConnachie, Illinois, 1994

• 2nd Citizen’s Conference on Dioxin

• Times Beach, Missouri, dioxin exposure

• children

• lymphocyte dysfunction

187

Immunologic Effects, II

• Repetto, World Resources Institute

• JAMA March 27, l996

• Pesticides and the Immune System

• immune system dysfunction in children

188

5. Endocrine Effects

189

Endocrine Effects

• Koppe, Netherlands

• Lancet Feb 3, l996

• thyroid neonatal dysfunction after dioxin exposure

• structural similarilty between dioxin and thyroxine molecules

190

Conclusions

Environmental

Economics

191

Comparison: Intel Corporation(and the Silicon Chip)

• New York Times , December 3, l995

• Semiconductor manufacturing plant

• New Mexico

• environment is “thousands of times cleaner than an operating room”

• Price: $ 1 Billion

192

Government of Ontario, I(and the human brain)

• Ministry of Environment Operating Budget

• l993/94 $ 390 million

• 1994/95, 95/96 240 “

• 1996/97 150 “

193

Government of Ontario II(and the human brain)

0

50

100

150

200

250

300

350

400

1994 1995 1996 1997

Annual OperatingBudget, MoE, 1994 - l997

194

Government of Ontario , III

• 1995 - 1998: MoE:

• number of pollution investigators: fell 28%

• total staffing: fell 32%

195

Government of Ontario, IV

• “We truly believe that this government has done more than any previous government to aid the environment. ”

Norman Sterling

June 22, l998

Minister of Environment

196

Provincial Auditor of Ontario,1996

• 226 air-pollutant standards required reassessment (1992 MoE study)

• substantial reductions needed in releases of air pollutants:“aggressive 3 year MoE plan”

197

Provincial Auditor , 1998

• Erik Peters

• followup November 4,1998

• “not a single one of the 226 air pollutant standards has been updated”

198

Minister of Environment, 1998

• Norman Sterling, Nov 4, l998

“When you are striking scientific-based standards, it does take a bit of time.”

199

Waste water standards, l996MoE enforcement

• 1000 violations

• sewage, pulp & paper, mining,chemical, etc

• 3 fines: Malette, Domtar, Russell

• FoI Act: Sierra Legal Defense Fund

• $20,000 charge levied

• 1 1/2 year process

• Privacy commissioner settled eventually

200

MoE, 1996, II

• Karen Vaux, spokeswoman:

• “Our priority is to get them to fix it and ensure that these type of occurrences don’t happen again.”

201

500 Journal articles on Toxics1992 - 1998

0102030405060708090

100

1992 1993 1994 1995 1996 1997 1998

Year

Number of articlesappearing 1992 -1998

202

Government of Ontario II

0

50

100

150

200

250

300

350

400

1994 1995 1996 1997

Annual OperatingBudget, MoE, 1994 - l997

203

Linkage

• Government funding for environmental work

• environmental research

204

Montreal Biosphere1999

• Multimedia presentation:

Mission Bios H20

• but: “in the last 15 years the situation has greatly improved”

• (How would you know?)

205

Dr. Pierre Belandformer commissioner, IJC

1998 GLU Citizen’s Hearings

“Governments are becoming more and more uninterested in the environment…..

Knowledge of the health of the Beluga in the St. Lawrence River is now uncertain. There is no 1998 data because there is no money to analyze and research.”

206

Eva LigetiEnvironmental commission, Ont

• State of Environment report 1998

• released 1999

• Ligeti met with new Minister of Environment August 1999, Tony Clement who said he “could do business with her”

• Ligeti fired the next day by the government• Globe and Mail, week of August 16, 1999

207

International Joint Commissionof the Great Lakes, 9th Biennial Report

• “The evidence is overwhelming: certain persistent toxic substances impair human intellectual capacity, change behaviour, damage the immune system and compromise reproductive capacity. The people most at risk are children, pregnant women, women of child bearing age and people who rely on fish and wildlife…….

208

IJC, 9th Biennial Report, II

• …as a major part of their diet. Particularly at risk are developing embryos and nursing infants.”

July l998

209