slowly poisoned: health consequences of pollution and environmental toxins martin donohoe, md, facp...
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Slowly poisoned: health consequences of pollution and
environmental toxins
Martin Donohoe, MD, FACPPortland State University
Campaign for Safe Foods, Oregon Physicians for Social Responsibility
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Overview
• Public health approach
• Air pollution
• Garbage
• Toxins
• Education/Corporate Influence
• Progress and Solutions
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Some Major Sources of Air Pollution
• Industry - #1• Agriculture• Automobiles• Indoor combustion of coal and
biomass for cooking, heating and food preservation
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Air Pollution
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Air Pollution
• Top ten most polluted cities in the world are in China and India
• Most polluted areas in US:
–LA, Houston, San Joaquin Valley in Central California
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Health Effects of Air Pollution
• Causes approximately 75,000 premature deaths/yr. in U.S.
• 1.8 million worldwide
• Linked to autism
– Due to higher levels of heavy metals and certain chlorinated solvents
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Health Effects of Air Pollution
• Air pollution causes asthma and impairs lung development and function
• Deaths from cardiopulmonary diseases correlate with air pollution levels in US cities–Both day to day and over time
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Health Effects of Air Pollution
• Increased admissions for CHF, asthma, COPD, PVD, and cerebrovascular disease
• Increased lung cancer mortality
• Decreased exercise tolerance, increased pulmonary symptoms
• Impaired sperm production
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Effects of Ozone Destruction
• Ozone hole over Antarctic (2½X size of Europe)
• Increased cataracts (UV damage)
• Increased lifetime melanoma risk
–1/1500 - 1930
–1/68 - today
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Automobiles
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Automobiles
• Number of autos-US: 1 car/2 people-Mexico: 1/8-China: 1/100 (increasing; leaded gasoline)
• Global auto population to double in 25-50 years
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Automobiles
• Average miles traveled/car/year in U.S.
– 1965 - 4,570 mi.
– 1975 - 6,150 mi.
– 1985 - 7,460 mi.
– 1995 - 9,220 mi.
– 2006 – 12,000 mi.
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Automobiles
• 25 lbs. of CO2 produced for every gallon of gasoline manufactured, distributed, and then burned in a vehicle
• U.S. energy costs exceed $500 billion/yr. (plus military costs to keep foreign oil flowing)
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Automobiles
• Average fuel efficiency of U.S. autos stagnant– Ford Model T – 25 mpg (1908); Avg. Ford
vehicle – 22.6 mpg (2003)
• Relatively low oil prices• Growing market for low-efficiency
pickups, minivans, and SUVs
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Automobiles: Alternatives
• Rapid transit
• Electric cars
–killed by oil companies, automakers, tire
manufacturers in early 20th century
–Convicted under Sherman Antitrust Act
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Automobiles: Alternatives
• Car sharing• Pay-as-you-drive auto insurance
• “Peak Pricing” and “Congestion Fees”– E.g., London → 30% decrease in traffic, 37%
increase in bus ridership, cleaner air
• Bicycles/walking– 30% of all trips by bike in Amsterdam; 2% in Portland,
OR
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Automobiles: Alternatives
• Busses
• Trains
–15 x more efficient per passenger than autos
• Natural gas and/or gasohol-generate less CO2
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Automobiles: Alternatives
• Telecommuting
• Biodiesel
– Vegetable oil-based fuel
– Problem: Cheapest biodiesel is oil from palm
trees; Indonesia, Malaysia deforesting areas
to plant palm trees, leading to increase in
global CO2
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Automobiles: Alternatives
• Solar cars
• Hydrogen-powered cars
–Byproduct = water
–Problem: Hydrogen production
requires fossil fuels
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Energy Spending/Research
• Since 1947, the U.S. has spent $145 billion on nuclear R and D vs. $5 billion on renewables R and D
• < 5% of the DOE’s budget pays for energy efficiency and renewables
• BP invests $100 million annually in clean energy = amt. it spends annually to market its new name and environmentally-friendly image of moving “Beyond Petroleum”
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Garbage
• 98% of the country’s total refuse is industrial waste; 2% municipal waste
• American produce 4.4 lbs/d garbage
• In a lifetime, the average American will throw away 6500 times his/her adult weight in garbage
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Garbage
• In one year, Americans generate 236 million tons of garbage
–30% recycled
–164 million tons thrown away
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U.S. Garbage Composition
• Paper and Paperboard - 39%• Yard Waste - 13%• Food Waste - 10%• Plastics - 10%• Metals - 8%• Glass - 6%• Wood - 5%
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U.S. Recycling Rates
• Tires - 22%• Plastic containers - 36%• Glass containers - 28%• Yard waste - 41%• Paper and Paperboard - 42%• Aluminum packaging - 54%• Steel cans - 60%• Auto batteries - 93%
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Garbage
• Landfills (2300 in US)
• Incinerators
• Garbage exports
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Annual World Production of Synthetic Organic Chemicals
• 1930 - 1 million tons
• 1950 - 7 million tons
• 1970 - 63 million tons
• 1990 - 500 million tons
• 2000 - 1 billion tons
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Toxins
• 6 trillion tons of over 85,000 chemicals produced annually– more than 80% have never been screened for
toxicity• Chemical manufacturers are not required to
prove safety– the legal burden is on the government to
prove that a product is dangerous– Consequence of 1976 Toxic Substances
Control Act
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Toxic Pollutants
• 85,000 known or suspected hazardous waste sites in the U.S.– Plus up to 600,000 lightly contaminated
former industrial sites (“brownfields”)• EPA estimates that there will be 217,000
new hazardous waste sites by 2033– Will cost hundreds of billions of dollars to
mitigate environmental impacts
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Toxic Pollutants
• 1 in 4 U.S. citizens lives within 4 mile of a Superfund site (approximately 1,305 sites listed; another 2,500 sites eligible)
• Taxpayers paying increasing share of cleanup costs
– 54% in 2003
– Vast majority presently
– Overall funding decreasing
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Toxins
• Body burden of industrial chemicals, pollutants and pesticides high
– Environmental Working Group (2004)found 287 pesticides, consumer product ingredients, and wastes from burning coal, gasoline, and garbage in umbilical cord blood• Many other compounds not even tested;
numbers undoubtedly higher
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Fetuses and Children are Most Vulnerable to Toxins
• Greater pound-for-pound exposure
• Immature, porous blood brain barrier
• Lower levels of chemical binding proteins, allowing more chemicals to reach “target” organs
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Fetuses and Children are Most Vulnerable to Toxins
• Organs/organ systems rapidly developing, thus more vulnerable to damage
• Systems that detoxify and excrete industrial chemicals are not fully developed
• Longer future life span allows more time for adverse effects to arise
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Toxins in breast milk
• Human babies at the top of the food chain• Fat soluble toxins concentrated in breast
milk– Benefits of breast feeding still exceed
risks• Birth defects, learning disabilities
increasing– Toxins play important role
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Toxins and gender
• Sex ratio changing:– Normal = 105 boys/girls born (skewed by
early male mortality)– Fewer boys being born in industrialized
countries• Other causes include obesity, older parental age,
stress, fertility aides
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Pesticides
• 5.5 billion lbs/yr pesticides– 1.2 billion lbs/yr in US
• EPA estimates U.S. farm workers suffer up to 300,000 pesticide-related acute illnesses and injuries per year– Possibly linked to higher rates of sarcoidosis
in agricultural workers– Pesticide-exposed men have impaired semen
quality, which is associated with reduced fertility and testicular cancer
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Pesticides
• NAS estimates that pesticides in food could cause up to 1 million cancers in the current generation of Americans
• Children living on or near farms score 5 points lower on IQ tests and other mental and verbal tests– May be due to pesticide exposure
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Pesticides
• 1,000,000 people killed by pesticides over the last 6 years (WHO)
• CA and NY are the only states currently tracking pesticide sales and use
• EPA currently allows pesticide testing in humans, despite strong opposition
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Pesticides
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Pesticides
• $2.4 billion worth of insecticides and fungicides sold to American farmers each year– Pesticides inhibit nitrogen fixation, decrease
crop yields– Evidence suggests pesticides actually
promote pests (vs. natural pesticides)• 30% of medieval crop harvests were
destroyed by pests vs. 35-42% of current crop harvests
– Implies organic farming more cost-effective
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Lead
• 2 million US children with elevated levels
• 120 million people with level > 10mcg/dL worldwide
• #s affected dropping
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Lead
• Affects brain development, associated with lower IQ– No safe level for neurological development
• Levels between 4 and 10 significantly increase risk of cardio- and cerebrovascular disease
• Elevated levels associated with crime and violent behavior
• Poor, African-Americans more commonly exposed
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Lead Poisoning: S/S, DX, and RX
• S/S: AP, CP, arthralgias, myalgias, HA, anorexia, ↓libido, ↓memory, anemia, nephropathy, HTN, cataracts, CV dz, cancer, ↓sperm count, lead line on teeth, basophilic stipling
• Dx: lead level, FEP (free erythrocyte protoporphyrin)
• Rx: ↓exposure, CsEDTA, DMSA
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Toxic Pollutants – Economic Costs
• Birth defects, learning disabilities increasing– Toxins play important role
• Americans pay more than $55 billion annually for direct medical expenses plus special schooling and long-term care for pediatric diseases caused by lead
• This excludes the greatest toxic pollutant - tobacco
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Mercury
• Released into air by coal combustion, industrial processes, mining, and waste disposal– 4500 tons/yr
• Travels throughout atmosphere and settles in oceans and waterways
• Bacteria convert it to toxic methyl-mercury
• Travels up food chain via fish
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Mercury
• 16% of women of childbearing age exceed the EPA’s “safe” mercury level
• Freshwater fish mercury levels too high for pregnant women to eat in 43 states
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Mercury
• ↓ coal burning
• New EPA ruling ineffective:
–allows cap-and-trade of power plant emissions
–Removes power plants from list of pollution sources subject to federal Clean Air Act
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Mercury: S/S, Dx, and Rx
• S/S: neuropsychiatric symptoms, inflammation of gums with excessive salivation, rash, nephropathy
• Dx: mercury levels in air, blood, urine (>100 mcg/l in blood and/or urine = toxic)
• Rx: chelation with BAL, penicillamine, DMPS, DMSA
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Toxic Pollutants
• Dioxin - from manufacturing, medical incinerators, defoliants (“Agent Orange”)-Love Canal
-cancers
• Nitrates/nitrites, trichloroethylene, vinyl chloride, ozone
• PFOA (Teflon): multiple health effects; being phased out by Dupont
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Hazardous Waste and Fertilizer
• Legal to dispose of hazardous waste by turning it into fertilizer
• e.g. Uranium-laced fertilizer in Oklahoma, lead-laced fertilizer in SW Wash., other mixtures containing arsenic, cadmium and dioxins
• Unclear if a health hazard
• No requirement that toxins be listed on ingredient labels
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Persistent Organic Pollutants
• Toxic, remain in environment long-term, resist degradation, can travel long distances
• Bioaccumulate - higher concentrations as you move up the food chain
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Persistent Organic Pollutants
• 10 of the these are endocrine disrupters– egs. - DDT, chlordane, heptachlor, dioxins,
PCBs– possible cause of decreasing male sperm
counts (100 million/ejaculate in 1950, 50 million in 1990) and increasing cases of hypospadias. early puberty, and breast cancer
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Toxic Pollutants and DNA
• Toxins can damage DNA• New evidence from rats of epigenetic
transgenerational effects of endocrine disruptors on male fertility in rats
• In 1938, 0.5% of men were functionally sterile– 8-12% in 2006
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Pesticides and Other Toxins Linked to Neurological Disease
• Parkinson’s Disease
• Autism
• Others
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Phthalates
• Found in construction materials, clothing, toys, cosmetics, pills, added to PVCs in IV tubing/other plastics
• 5 million metric tons consumed by industry per year (13% in the U.S.)
• Exxon Mobil and BASF dominate the market
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Phthalates
• Associated with:
–demasculinization and alterations in genitalia in male infants
–lower testosterone levels
–lower sperm counts in adults
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Phthalates/PVCs and Medical Devices
• EPA regulations weak, based on 50-year old study
• FDA has advised healthcare providers to use alternatives to DEHP-containing PVC medical devices, esp. in neonatal units
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Environmental Racismand Toxic Imperialism
• Environmental Racism– waste dumps/incinerators more common in
lower SES neighborhoods– “Cancer Belt” (Baton Rogue to New Orleans)– “White residential neighborhoods” - 1.7 acres
parkland/1000 residents– “African-American neighborhoods” - 0.3
• Toxic Imperialism
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Mining and Pollution: Gold
• Cyanide “heap leach” gold mining–cyanide dripped over crushed
rock to extract gold
–taxpayers often stuck with cleanup costs
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Mining and Pollution: Gold
• International gold mining linked to human rights abuses
• 84% of gold becomes jewelry–To save the environment, consider
not buying gold jewelry
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Should I Send Flowers?
• Most commercial flowers grown in sealed greenhouses in developing countries (e.g., Colombia, India China, Mexico)
• Carry 50 times the amount of pesticides allowed on food– One fifth of chemicals used banned in U.S.
• Workers underpaid, 50-60% suffer from pesticide poisoning
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Electronic Waste
• Only 5-10% of computers recycled
• Most sent overseas, children disassemble
• EU now requires electronics firms to recycle and to eliminate lead, cadmium and mercury from their products
• Dell, www.computertakeback.com
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Electronic Waste
• European laws re extended producer responsibility and product liability
–Similar San Francisco resolution
• Maine passed first law requiring elctronic manufacturers to pay for recycling their discarded products
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Medical Waste
• The 6,000 US hospitals generate 2 million tons of waste per year; clinics and doctors’ offices an additional 700,000 tons–850,000 tons incinerated
•15% infectious waste
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Medical Waste
• Incinerated pollutants include dioxin, mercury, cadmium and lead
• EPA regulations weak
• Segregation and alternatives to incineration would cost 93 cents/patient/day
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Medical Waste
• One hospital bed generates between 16 and 23 lbs/day of waste
• Solutions:
– 80% of thermometers no longer contain mercury
– Remove PVCs from medical supplies (e.g., IV tubing)
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Water Pollution
• 40% of U.S. waters are unfit for fishing or swimming– beach closings
• The Jordan River (believed to be the gateway to the Garden of Eden and the place where Jesus was baptized) is now more than 50% raw sewage and agricultural runoff
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Willamette River
• One of the most polluted rivers in the American West– Arsenic, lead, mercury, DDT
• 5.5 mile stretch Superfund site
• Current law allows polluters to calculate discharges using “toxic mixing zones” to get around limits on discharges
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Water
• In developing countries, 90-95% of sewage and 70% of industrial wastes are dumped untreated into the local water supply
• 13,000-15,000 deaths per day worldwide from water-related diseases
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Water Pollution:Bathtub=Toilet=Source of Drinking Water
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Infamous Industrial Disasters
• Minimata, Japan, 1920s-1970s (Chisso Corporation) - methylmercury poisoning
-400 dead; 10,000 injured• Bhopal, India, 1984 (Union Carbide) -
methyl isocyanate gas–7000-10,000 dead within 3 days, 15,000-
20,000 more over next 10 years; tens of thousands injured
–persistent water and soil contamination
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Minimata DiseaseW Eugene Smith
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Infamous Industrial Disasters
• Chernobyl, USSR, 1986 - nuclear power plant explosion
-25-100 dead, up to 1,000 injured acutely, NCI estimates 10-75K thyroid cancers
• Alaska, Exxon Valdez, 1989 - oil spill-wildlife devastated, $5 billion damage
• 2006 BP Alaskan pipeline ruptures
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Since Exxon Valdez
• At least 1.1 million tons of oil have spilled from tankers worldwide
–Equivalent to 30 Valdez incidents
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Oil Pollution is Expensive to Clean Up
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Oil Slicks Kill Marine Life
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The Military and Pollution
• World’s single largest polluter
• 6-10% of global air pollution
• 2-11% of world raw material use
• 97% of all high level and 78% of all low level nuclear waste
• Pentagon generates 500,000 tons toxic waste/year
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The Military and Pollution
• “The more birds that the [Department of Defense] kill[s], the more enjoyment [people] will get from seeing the ones that remain: ‘Bird watchers get more enjoyment spotting a rare bird than they do spotting a common one.’”– 2002 court summary of the U.S. Defense
Department’s argument for exemption from the Migratory Bird Treaty Act of 1918
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The Military
• Small arms and rocket propelled grenades
• Land mines
• Nuclear, chemical and biological weapons
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Military Waste
• More than 27,000 toxic hot spots at the pentagon’s 8,500 properties
– less than 400 toxic waste dumps have been cleaned up
– costs to clean - immense: likely never to be completed
• Military exempt from most environmental regulations
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Worrisome Trends
• GATT
• NAFTA
• CAFTA
• Other trade agreements
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SLAPP/SLAPP-Back
• Strategic Lawsuits Against Private Parties/ Countersuits
• SLAPPs- designed to harass environmental groups, deplete their financial resources through threatened or actual litigation
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Politics: Bush Administration
• Key administrators/committee members/regulators former industry representatives and/or lobbyists
• Corporate profit before public good
• Unsound/distorted/suppressed science
• Eco-harassment– Criminalizing activists
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Bush Administration
• Rollbacks of key environmental laws
• Lax enforcement of existing laws
• Huge tax cuts primarily benefit wealthy
• Federal and state government deficits astronomical– Program and funding cuts
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Would You Sign a Petition to Ban Dihydrogen Monoxide?
1. It can cause excessive sweating and vomiting
2. It is a major component in acid rain
3. It can cause severe burns in its gaseous state
4. It can kill you if accidentally inhaled
5. It contributes to erosion
6. It decreases effectiveness of automobile brakes
7. It has been found in tumors of terminal cancer
patients
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Environmental Ignorance
• A majority of Americans believe that electricity in the U.S. is produced in nonpolluting ways– 25% knew that majority (70%) comes from oil,
coal and wood• 1/3 assumed that spent nuclear fuel (from our
104 plants) is stored “in a deep underground facility in the West”– Only 17% were aware that it is mostly stored
on-site at powerplants pending a long-term solution (30,000/tons)
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Pseudoscientific Beliefs
Percentage of Americans who believe “at least to some degree” in these “phenomena”
1997 1976
• Astrology 37% 17%• UFOs 30% 24%• Reincarnation 25% 9%• Fortune-Telling 14% 4%
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Greenwash
• Public relations / ad campaigns-Chevron’s “People Do” Campaign, butterflies/refinery-Dupont Freon Campaign in 1970’s-Grants to a few scientists who challenge environmental warnings-tobacco ads in 1950’s
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Astroturf and Corporate Front Groups
• Artificially-created grassroots coalitions
• Corporate front groups– The American Council on Science and Health– The Oregon Lands Coalition– National Wilderness Institute– The Foundation for Clean Air Progress
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Corporate PR tactics
• Invoke poor people as beneficiaries
• Characterize opposition as “technophobic,” anti-science,” and “against progress”
• Portray their products as environmentally beneficial in the absence of (or despite the) evidence
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Sponsored Environmental Educational Materials
• Corporate-sponsored and supported by a loose coalition of antiregulatory zealots, corporate polluters, lapdog scientists and misguided parents
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Sponsored Environmental Education Materials (Examples)
• Exxon’s “Energy Cube”
-“Gasoline is simply solar power hidden in decayed matter”
-“Offshore drilling creates reefs for fish”
• Pacific Lumber Company
-“The Great American Forest is. . . renewable forever”
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Sponsored Environmental Education Materials (Examples)• International Paper
-“Clearcutting promotes growth of trees that require full sunlight and allows efficient site preparation for the next crop”
• American Nuclear Society’s “Activities with the Atoms Family”
• Dow’s “Chemipalooza”
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“Doubt is our product”
Brown and Williamson Tobacco Company Memo, 1960s
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Progress and Solutions
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The “Benefits” of Sterility-Causing Chemicals in the Workplace?
12 September 1977
Dr. Eula Bingham, Assistant Secretary for Occupational Safety and Health[Regarding] worker exposure to DBCP.While involuntary sterility caused by a manufactured chemical may
be bad, it is not necessarily so. After all, there are many people who are now paying to have themselves sterilized to assure they will no longer be able to become parents...
If possible sterility is the main problem, couldn’t workers who were old enough that they no longer wanted to have children accept such positions voluntarily? Or…some [workers] might volunteer for such workposts as an alternative to planned surgery for a vasectomy or tubal ligation, or as a means of getting around religious bans on birth control when they want no more children?
Sincerely,
Robert K. Phillips, National Peach Council
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Environmental Success StoryThe Montreal Protocol (1987)
• Phaseout of chlorofluorocarbons (CFCs) by 1996
• Developed in 1920s; the chief working fluid in
refrigerators, aerosol spray cans, insulating foams,
and industrial solvents and cleaning agents
-1 million tons/year manufactured in 1970s
-major cause of Antarctic and Arctic ozone holes
-current substitute, HCFCs, much less damaging to ozone layer, also to be phased out
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The Montreal Protocol
• 1980 - 880,000 tons CFC’s produced worldwide
• 1996 - 141,000 tons
• 1996 - all industrialized nations stopped producing CFC’s
• Today: Illegal CFC trade, once quite large, starting to taper off
• 2010 - rest of world expected to stop
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The Montreal Protocol
• However, the Bush administration has withdrawn from the Treaty, under pressure from agribusiness and chemical lobbyists, who favor increased spraying of the pesticide methyl bromide (the most dangerous ozone-destroying chemical still in use)…..
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Toxic Pollutants:The Basel Convention
• The Basel Convention on the Control of Transboundary Movements of Hazardous Wastes (designed to control dumping of hazardous wastes from the industrialized world in developing countries)
• Despite being the largest producer of toxic pollutants in the world, the U.S. has signed but not ratified this agreement
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Persistent Organic Pollutants
• UN Environmental Program organizing worldwide phaseout of top 12 through the Stockholm Convention on Persistent Organic Pollutants– Including DDT, PCBs, and dioxins
–US has signed, but not ratified
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Lead
• American Assn. of Pediatrics now recommends toxic lead be removed from all housing and that all children be tested once during their first two years
• 25% of U.S. homes still contain significant amounts of lead-based paint– Cost of removing lead from 4 million seriously
affected homes: $28 billion• Cost savings each year thereafter: $43 billion
(higher IQs, increased earning power, increased tax revenue, lower health care costs, less crime)
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Leaded Gasoline
• Banned in Canada in 1990, US in 1996 (after 25-year phaseout period), EU in 2002, Africa in 2006– Ban fought by industry for decades– Scientists harassed
• Many countries still sell leaded gasoline:– Indonesia, Venezuela, North Korea, Iraq,
Afghanistan, Jordan, Syria, Yemen
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REACH
• Registration, Evaluation, and Authorization of Chemicals
• European Treaty requiring companies to test chemicals already on the market by a set timetable and test new products before putting them on the market
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REACH
• Cost of evaluations < 1% of chemical industry’s total sales
• Economic analyses show REACH could bring environmental benefits worth €95 billion over the next 25 years and result in health cost savings of €50 billion over the next 30 years
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Medical Waste
• Organizations:– Health Care Without Harm– Green Health Center Movement
• Hospitals built and operated on more environmentally sosund principles save money (NAS):– Costs recovered more quickly, patients get better
sooner, patients’ families happier, medical errors reduced, steaf turnover/absenteeism/workers’ comp claims drop
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SolutionsBased on the Precautionary
Principle“When evidence points toward the potential of an activity to cause significant, widespread or irreparable harm to public health or the environment, options for avoiding that harm should be examined and pursued, even though the harm is not yet fully understood or proven”
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The Precautionary Principle:Practical Essentials
• Give human and environmental health the benefit of doubt
• Include appropriate public participation in the discussion
• Gather unbiased, scientific, technological and socioeconomic information
• Consider less risky alternatives
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The Precautionary Principle
• Endorsed by APHA, ANA, others
• Puerto Rico, San Francisco have adopted, among others
• Big business, US Chamber of Commerce oppose
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The Precautionary Principle
• "All scientific work is incomplete - whether it be observational or experimental. All scientific work is liable to be upset or modified by advancing knowledge. That does not confer upon us a freedom to ignore the knowledge we already have, or to postpone the action it appears to demand at a given time." (Bradford Hill, 1965)
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Contact Information
Public Health and Social Justice Website
http://www.phsj.org