CHE’s Top 10 Environmental Health Stories, October through December 2012

For our second quarterly Top 10 list, we again selected news articles, journal articles, policy decisions and events that we consider “game-changers” in one way or another: they all have had a significant impact, or are likely to have a significant impact on thinking and action in the field; they’ve changed the conversation on a topic or expanded the scope of the conversation to a new audience or awareness; and/or they are likely to be pivotal in defining a new trend.

These were selected from several dozen candidates for this list:

1. Workshop ‘Low Dose Effects and Non-Monotonic Dose Responses for Endocrine Active Chemicals’
   This groundbreaking international meeting in September moved the conversation about low-dose effects from endocrine disrupting chemicals significantly forward in re-examining the ways in which chemicals are tested for endocrine disrupting properties and how risk to human health is managed.
   See also a report from the World Health Organization: Endocrine disrupters and child health; movement from the EPA: EPA responds to scientists’ concerns, initiates new effort for low-dose, hormone-like chemicals and an article in Nature magazine: Toxicology: the learning curve.
   

Getting the Questions Right

Elise Miller, MEd
Director

With epigenetics on the cover of Time magazine this week, public awareness of the links between our genes, our environment and our health has never been so widespread. Throughout history, breakthroughs in understanding have been largely shaped and guided by the questions we choose to ask. After World War II, the questions most researchers as well as policymakers in the U.S. were asking focused on how to build infrastructures to catalyze the growth of large-scale industrial processes and products – from pesticides to plastics to pharmaceuticals. The underlying assumption was that we could improve on nature without necessarily understanding or abiding by the natural principles that have allowed life to be nourished and sustained for the previous tens of thousands of years.

In just the last generation, however, new and pressing questions have begun to emerge. For example, why – with the vast availability of food products, abundance of sophisticated technologies, and myriad advances in medicine – are more and more people facing chronic diseases and other health problems in the U.S. as well as experiencing a lower quality of life? Why – if being successful means driving bigger cars and having bigger houses – would we be seeing glaciers melting at unprecedented rates and millions of new climate refugees?

Clearly, we can no longer delude ourselves that ‘improving on nature’ is predicated on disregarding it – and instead, ask how can we work within the systems and imitate the processes that have made this planet life-sustaining to date?

Fortunately, there are more and more researchers and others who are asking just that, and perhaps none more energetically than those in the increasingly robust field of green chemistry. Just a couple weeks ago, Paul Anastas, PhD, who is considered by some ‘the father of green chemistry’, was finally appointed Assistant Administrator of the Office of Research and Development at the EPA. For some years now, he and other colleagues – including many of you – have suggested that a number of the major problems we see today, such as the adverse health consequences of toxic exposures and climate change, are in large part due to not asking the right questions in the first place (or perhaps, as some would argue, there were simply too few people in power asking those essential questions). By contrast, those in green chemistry are urging us to ask a set of principled questions before creating new products and technologies, so that, ultimately, the trajectory of our choices can be as biologically and ecologically benign as possible. 

This month CHE is hosting or co-sponsoring three national/international calls that are intended to help us ask better questions so that our pursuits can be more in keeping with the natural systems in which we have evolved and in which future generations will live. The first is a CHE Café Call with Elizabeth Grossman, author of the recently published book Chasing Molecules, which describes how green chemistry has the potential to not only lead to safer products and materials, but reduce the health impacts of climate change. The next is a CHE Partner call on the potential health impacts of chemicals that can disrupt thyroid dysfunction and how chemical policy reform can help address these concerns. And the third call will be co-sponsored with SeaTrust and IGI and feature two colleagues working at the intersection of climate change and health and attended the recent Copenhagen climate change talks. For more information on these calls and how to register, please view the left-hand column on CHE’s home webpage.

I truly look forward to collaborating with you in the New Year in order to hone our capacity to get the questions right as we work towards a healthier tomorrow.

Reflections on 2009

Elise Miller, MEd
Director

Maybe it’s just me, but it feels like the environmental health train picked up some extraordinary speed in 2009. Starting with the National Academy of Science’s report “Science and Decisions: Advancing Risk Assessment,” which makes recommendations to address the current limitations of risk assessment; moving to the appointments of Dr. Lisa Jackson as the new EPA Administrator and Dr. Linda Birnbaum as the new Director of NIEHS; then to the seminal publication of The Endocrine Society’s statement on the health implications of endocrine disrupting chemicals (EDCs) (and the subsequent resolution on EDCs passed by the American Medical Association); the publication of the “Common Agenda for Health and the Environment‘” by the Lowell Center for Sustainability with input from hundreds of colleagues, offering principles for implementing concrete steps towards a healthier future; Nicholas Kristof’s compelling series of New York Times op-eds focused on EDCs; Administrator Jackson’s consistent message that we must ensure children’s health is at the center of every regulatory and policy decision; the significant push to prioritize the health of vulnerable populations in the climate change discussions; and the increasing momentum on chemical policy reform on state and national levels – to name just a few noteworthy events over the course of the year.

I also want to acknowledge that many of you, our CHE partners, played pivotal roles in these and other remarkable actions and publications this year – often behind the scenes and in understated ways, but with no less potency. And of course, what we see manifesting today is built on decades of courageous and tenacious efforts of those on the front lines of science and on the fence lines of communities.

So what is next? I believe the burgeoning science and reflective discussions in CHE and elsewhere are encouraging us more and more to figure out how to move not only one train faster down a track, but to understand how myriad tracks interact and loop back and join together at different times and in different modalities – in short, to apply complexity theory to ecological health in concrete, effective terms. Taking a systems approach would entail finding meaningful ways to address the fact that, as Michael Lerner, co-founder and Vice Chair of CHE, summarized in a recent e-mail to the CHE Science listserv, “a high number of different endogenous and exogenous factors in and around the human organism encounter different inherited genetic dispositions and different patterns of gene expression so that different people reach the ‘final common pathways’ of different diseases for different combinations of reasons.” We are seeing this in the scientific literature on metabolic syndrome, autism, Alzheimer’s and many other conditions. The task at hand then is to press for restructuring our regulatory system, our food system, our health care system, and our economic system to make health, justice and sustainability the highest priorities — in fact, to make those inalienable rights of current and future generations. Daunting, yes. Impossible, no.

We each are engaged in various aspects of this dynamic system, and we each need to stay focused on our part to ensure its success. At the same time, we need to consistently review our efforts in relationship to the whole. This is nothing new. It just gets harder to do as our understanding of the variables and complexity grows. That said, if we bring our intelligence, creativity and wisdom to our collective conversations and initiatives, we can and will make healthier choices based on the best available science. That is what CHE is all about. In 2010, we invite you to continue to contribute your expertise and insights to our common work.  

Warmest wishes for the holidays and a healthier-than-ever New Year.

Changing the Landscape

Elise Miller, MEd
Director

The American Medical Association (AMA) took an unprecedented action yesterday: It unanimously passed a resolution calling for new policies to decrease public exposure to endocrine disrupting chemicals (EDCs) [read more] based on the Endocrine Society’s seminal scientific statement on EDCs published last summer [read the statement]. Both The Endocrine Society Statement and the AMA’s resolution mark an historical turning point for mainstream medical associations. For the first time, tens of thousands of prestigious health professionals are saying in no uncertain terms:

Exposures to many industrial chemicals are contributing to the epidemic of chronic diseases and disabilities, including diabetes, obesity, learning and developmental disorders, infertility and other reproductive health problems. 

• We have enough science to undertake proactive health measures.
• The risk to public health is too great to wait any longer. 
• We need to act now to implement health protective policies and regulations.

Many CHE partners were involved in catalyzing this remarkable action. We now would like to encourage other health-related professional societies to adopt similar resolutons to signal to national leaders and policymakers that fundamental chemical policy reform can no longer be side-lined. In fact, chemical policy reform is not only integral to health care reform, as I suggested in last month’s CHE e-newsletter, but to climate change as well. EPA Administrator Jackson made this point on Monday in her remarks at the American Public Health Association conference. She announced greenhouse gas emission standards for automobiles, a first for the EPA, saying the limits would mean “less harmful pollution that sends people to the hospital with asthma, heart disease, and any number of other conditions.”

In this context, what if we prioritized these same health-focused principles in climate change decisions across the board? That is, in essence, what CHE organizational partners, the Health and Environmental Alliance (HEAL) and Health Care Without Harm (HCWH), are calling for in a new campaign entitled “Prescription for a Healthy Planet.” To date, protecting public health has been essentially left out of the conversation in international talks on climate change. At the upcoming Copenhagen summit in December, however, we have an opportunity to ensure that children’s health and that of other vulnerable populations are prioritized. As stated in the “Prescription”, “a fair and binding international agreement in Copenhagen means: less global warming, less illness, lower healthcare costs, better health for the world population and a healthier planet.” This sounds promising. But right now very little research and discussion has focused on climate change and health.

What we do know is that children will be the most impacted by climate change. Nine percent of American children already suffer from asthma and those attacks will become more numerous and severe with increased air pollution and ozone levels – and of course, the number of children affected in developing countries, where there may be even less regulation on pollutants, will likely be far higher. In addition, we will be faced with increased exposures to industrial chemicals as recently outlined by the World Health Organization. For example, with more extreme storms and floods, there will be greater runoff of chemicals used in urban and agricultural areas into surface and ground waters. With increased drought, non-volatile chemicals and toxic metals will concentrate and rapidly enter groundwater supplies through parched soil when rain finally comes. In addition, global warming will release chemicals currently trapped in glacial ice, and changing weather patterns will move persistent chemicals through water and air streams in ways previously unanticipated. And this doesn’t even begin to describe other concerns about increased infectious diseases and the challenges of whole populations migrating elsewhere because of rising sea water and less fertile land.

All of this is to say that the AMA and myriad other health professional societies in the US and abroad are essential to figuring out solutions to this thorny nexus of pressing public health issues, namely: chemical policy reform, health care reform and the impact of climate change on human health. Through ongoing efforts to translate the best available science for lay audiences and to incubate strategic health-focused initiatives, I have no doubt CHE partners can continue to change the landscape in which these major decisions – decisions affecting all of us and future generations – are made.

Toward a Sustainable, Health-based Food System

Elise Miller, MEd
Director

Most of us have heard of Michael Pollan’s ‘An Eater’s Manifesto’: “Eat food. Not too much. Mostly plants.” Excellent advice for those of us who are fortunate enough to have a variety of food choices. The challenge of course is that our current industrialized food system (and related sectors such as advertising) encourages us to eat lots of food-like substances and high on the food chain—and for many in inner cities, finding a fresh vegetable, much less an organic one, can be as rare as gold.

In addition to these challenges, hormone disruptors (also known as endocrine disrupting chemicals) are found in everything from the feed given to animals to the pesticides sprayed on crops to the plastic additives in packaging—all of which we end up ingesting. These chemicals are now associated with a range of health concerns, including obesity, diabetes, certain cancers, neurological disorders and reproductive health problems, as the Endocrine Society described in their recent consensus statement. And then there are issues such as the use of antibiotics in food, the importation of foods that aren’t required to meet US standards, and food-borne viruses like e.coli.

The good news is that organizations on national, state and local levels are beginning to press for a health-based food system. For example, the American Medical Association (AMA) recently adopted a policy resolution “in support of practices and policies within health care systems that promote and model a healthy and ecologically sustainable food system.” In addition, the Institute of Medicine (IOM) and The National Research Council (NRC) released a report last week that emphasized the need for local governments to create environments in which people make healthful lifestyle decisions. The statement calls for municipalities to “discourage fast-food restaurants near schools and playgrounds through zoning, provide tax incentives for groceries in underserved areas, and create nutritional standards for government-run after-school programs.” In addition, myriad groups across the country are promoting Community Supported Agriculture (CSAs) and working with local school districts to develop “farm to school” initiatives that would help local farmers as well as improve the quality of the food served in schools.

The question is whether these actions are enough to shift the economy towards a sustainable, health-based food system given the deeply intertwined and diverse set of players involved in the production and marketing of food. In an ecological or systems biology model, all the interacting factors work in concert, each as a complement to the other and each supporting the system as a whole. Right now at the federal level, the Department of Agriculture doesn’t collaborate with the Food and Drug Administration which doesn’t work with Environmental Protection Agency nor the Department of Housing and Urban Development nor the Department of Transportation, and so on—at times, in fact, some of these agencies even work at odds. Then on the local level, public health departments rarely work with school districts or planning commissions, certainly not in regards to the availability of high quality food.

This of course means we need to coordinate these efforts more effectively on every level if we are to improve the health of current and future generations. If you are interested in learning more about these issues and what we can do to address then, please join us on our next CHE Partner call entitled Food Matters: The Impact of Food Systems on Public Health to be held on September 22, 2009.

Mixtures Are the Rule, Not the Exception

John Peterson Myers, PhD, CEO of Environmental Health Sciences

No one experiences just one chemical at a time. Hundreds of synthetic chemicals contaminate every living person. Yet almost all applied and basic science underpinning modern regulation has tested one chemical at a time. 

The graphs to the left are gas chromatographs of baby urine obtained from the diapers of two infants at 1 year of age.  The upper trace is from an infant that was breast fed. The lower was bottle fed. Even at this young age, these babies were carrying many different contaminants.  From Bush et al. 1990. 

This raises important questions about how chemicals interact with one another. If there is an interaction, do chemicals in combination produce more of an effect than alone, and if so, are the interactions predictable on the basis of the effects of single chemicals, one at a time?

Mixtures are one of the huge unknowns in toxicology. The numbers of chemical combinations experienced by people living in the real world is staggeringly large. With any one person carrying detectable levels of up to several hundred chemicals at one time, and with the mixtures varying from person to person, it is beyond the capacity of modern science to test all mixtures, or even all common mixtures. At the pace of modern regulatory science, it literally would take thousands of years to resolve issues of safety using experimental methodology.

What is known, however, raises disquieting questions. While studies are few, they clearly demonstrate that chemicals can interact with one another in causing effects.

For example, a team led by Dr. Warren Porter, a professor at the University of Wisconsin, reported in September 2002 about the impact of a off-the-shelf mixture of dandelion herbicide available from many local hardware stores. Instead of testing the components of this mixture one-by-one, as do EPA and the companies that sell pesticides, Porter’s team simply used the mixture as it was sold. Their results were dramatically different from what the standard testing reveals. Very low-level exposures to the mixture caused significant reductions in litter size of exposed pregnant mice, at levels where by themselves the components produced no effect.

One of the most elegant experiments of this sort to date has been carried out on mixtures of estrogen with weakly estrogenic contaminants by Rajapakse et al. (2002). They showed that multiple chemicals in combination with one another, each at levels too low to cause a discernible effect by itself, together dramatically increase the response to natural estrogen, 17ß-estradiol.

But while experimentation may be manageable with small numbers of compounds in mixtures, as noted above, humans are contaminated by many contaminants simultaneously, most of which are virtually unstudied with respect to specific endocrine impacts. The elegant models developed by Rajapakse et al. may prove difficult to extrapolate to complex mixtures.

Synergistic interactions are the most problematic, because they indicate that the effects of multiple chemicals together can be significantly more powerful than might be predicted simply by adding up their effects one at a time. Regulatory science rarely incorporates any interactions; it is incapable, at present, of coping with synergies. Thus synergy profoundly challenges traditional risk analysis calculations.
 

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Bush, B, RF Seegal, and E Fitzgerald. 1990. Human monitoring of PCB urine analysis. In: Organohalogen Compounds Vol 1: Dioxin ’90–EPRI Seminar, Toxicology, Environment, Food, Exposure-Risk (Hutzinger O, H Fiedler, eds.). Bayreuth: Ecoinforma Press. pp 509-513.

Cavieres, MF, J Jaeger and W Porter. 2002. Developmental Toxicity of a Commercial Herbicide Mixture in Mice: I. Effects on Embryo Implantation and Litter Size. Environmental Health Perspectives 110: 1081-1085. 

Rajapakse, N, E Silva and A Kortenkamp. 2002. Combining Xenoestrogens at Levels below Individual No-Observed-Effect Concentrations Dramatically Enhances Steroid Hormone Action. Environmental Health Perspectives 110:917–921.