Worker Exposures

Sorry I haven't posted again in a while. I fell on the ice and broke my arm. I'm sure ready for spring!

I frequently get e-mails from readers sharing their stories or asking me questions. Recently I received an email from a reader who explained that she had been exposed at work over a three-year period to industrial styrene, MEK peroxide and acetone. She wondered if these could have contributed to her health problems, which include shortness of breath, hoarseness, and stomach problems. The short answer is yes. I recommended that she search for an environmental doctor at the American Academy of Environmental Medicine website and contact an attorney who handles workmen's comp cases. She's done both and workmen's comp is now sending her to some specialists, so hopefully with attention she can get better. But I'd like to use her case as an example for other readers to learn how to gather information about the chemicals they may have been exposed to.

There are dozens of really great places online to learn about chemicals and what they might be doing to your health. Admittedly, some of them lead to information that requires a Ph.D. to understand, but there are a fair number that are geared toward regular people. For this kind of search I recommend starting with the scorecard.org website. Click on chemical profiles under health hazards and entered the name of the chemical that you're concerned with. I plugged styrene into the database. I learned that styrene is a suspected carcinogen, cardiovascular or blood toxicant, developmental toxicant, endocrine toxicant, gastrointestinal toxicant, immunotoxicant, kidney toxicant, neurotoxicant, reproductive toxicant, respiratory toxicant, and skin or sense organ toxicant. Clicking on the health hazards link for styrene, I learn that the worker exposure hazard score, which “indicate[s] how a chemical compares with other [chemicals] in terms of its capacity to impact the health of a factory worker,” is quite high.

Next I check MEK peroxide. It's a gastrointestinal toxicant, respiratory toxicant, and skin or sense organ toxicant. Acetone is a cardiovascular or blood toxicant, developmental toxicant, endocrine toxicant, gastrointestinal toxicant, kidney toxicant, neurotoxicant, reproductive toxicant, respiratory toxicant, and skin or sense organ toxicant. Of course, in this reader’s case she was being exposed to all three so there are cumulative and additive impacts.

For each chemical ScoreCard has multiple layers of information that allows you to drill down deeper and deeper. For example, for acetone I clicked the link to the Centers for Disease Control and Prevention's Agency for Toxic Substances and Disease Registry Public Health Statement. This brought me to a website that explains in fairly understandable language about acetone—how it enters the environment, how people may be exposed, what happens to it in the body, and what its effects on health are.


The good news is that today anyone can educate themselves using a service like ScoreCard. Here's few other points people should consider for workplace exposures:

1. The families of workers who are exposed in workplace often suffer from the same exposures as the family member who actually goes to work. This is because that family member comes home with their clothes Saturated in the chemicals. They go into the wash with the rest of the family's clothing, thus causing a sort of trickle-down exposure. As Dr. Bernhoft said in the post about detoxification, almost all chronic illnesses are the result of an interaction between genes and environment, so it is possible that the worker would not show symptoms from an exposure, yet a family member whose genetics are so disposed, would show symptoms from the family member’s exposure who goes to the workplace.

2. Exposures can also occur “across the fence line” for people living near industrial facilities that use chemicals. Want to learn if you're across the fence line from something? Is it EPA's toxic release inventory database where you can search by zip code to learn about larger industrial chemical users in your area.

3. Sometimes “industrial” is a misleading term. Workplace exposures can also come from small businesses such as welding shops or auto repair shops, painting businesses, art businesses, beauty salons, and other small businesses that people do not usually considered particularly hazardous.
4.From what I hear workmen's compensation officials may be less than fully knowledgeable about the health impacts of chemicals on workers. This is why I recommended the reader contact an attorney who handles comp cases. I think this is changing as both doctors and bureaucrats are becoming more educated about the impacts of even low-level exposures over long periods, but it is something to be aware of.

Exposed

Yesterday Terry Gross, the host of NPR's Fresh Air, did an interview with Mark Schapiro. Schapiro is the author of Exposed: The Toxic Chemistry of Everyday Products, and What's at Stake for American Power, which I reviewed when it first came out. The program was excellent, and Schapiro said a couple of things that stuck with me:

1.) Gross asked Schapiro how researching the book changed the consumer choices he makes. He said: What really gets me is, I like to have the information, and industry and the government have gone to extraordinary lengths to prevent me, and you, and everybody else, from having the information about these kinds of substances, so that you can make a choice. I think at the very minimum, that is something people can demand. How has it changed how I do things? I smoke, I enjoy smoking, but I know what I am doing, I know the risks and I know what is involved with a cigarette. So the thing that gets me about this whole issue is, what you don't know. Get the information out there and people can make decisions about the risks they are willing to take, but right now the information isn't out there.

2.) At the end, Gross said, "Thanks for all the bad news." Schapiro came back with this: I don't see this book as a bad-news book. I have been following environmental topics for years and I have found these arguments over and over and over again. Environmentalists say, 'Take this stuff out, it's really dangerous' and industry comes back and says 'Get real. We have got to make trade offs in modern society, and we are going to end up throwing people out of work, and it is going to be too expensive, and it will be an economic catastrophe for our country, plus the stuff isn't dangerous anyway.' To be honest I got tired of that dynamic, it gets like Kabuki theater, the same arguments back and forth. Then I started following what was happening in Europe and I said, 'Hey, wait a minute. The world's major economy is requiring that things be done differently, and so what is the reaction?' I started looking at what is the effect in Europe, and the economic catastrophe that was predicted never happened. So it has been a bluff, over and over and over here in the United States as to what is-and-isn't possible. So I see it as the opposite of a bummer. I see it as kind of a new way of looking at things and a new way of looking at what is possible.

Yesterday morning, I had breakfast with a friend. He said something similar to me, about my blog being bad news. But like Schapiro, I don't see knowledge as bad news. I see it as empowerment. When we do know about all this scary stuff, we can weigh risks, we can make educated decisions, and we can demand change. As consumers, I truly believe that we have remarkable power! Vote for safer products every time you go to the store. Let corporations and government know you won't settle for less than full disclosure so you can make educated choices. They will listen.

(Listen to the Fresh Air interview here.)

Environmental and Occupational Causes of Cancer

A new report by the Cancer Working Group of the Collaborative on Health and Environment reviews the state of our knowledge about the causes of cancer.

First, a bit of history: Sir Richard Doll was a famous British epidemiologist. In 1954 he was one of the first scientists to warn of the link between asbestos and cancer. Through the 1950s and 1960s, he continued to warn about the link between various exposures and cancer, but then in the 1970s and beyond, he seemed to back away from making such connections. By the 1980s, he was publishing oft-cited scientific papers suggesting that over 90% of all cancers were linked to lifestyle, and that fewer than 4% had any environmental or occupational connection. His numbers were widely used to justify a status-quo approach to cancer research, and to support the pursuit of new treatment options rather than implementing prevention strategies.

Doll passed away in 2005. His papers were donated to the Wellcome Library, a British medical library. Researchers reviewing the collection discovered that Doll had been on the dole: he received regular payments as a "consultant" from Monsanto, DOW Chemical, Turner & Newell (an asbestos company) and the Chemical Manufacturers Association, beginning by 1979 and continuing almost to his death. He never disclosed his relationship with these special interests, even when testifying before government entities around the world about the safety of the chemical products they made.

Blame smoking. Blame bad eating habits. But don't blame the chemicals we're exposed to. Hmmm. You can read more on the Doll story, here, at Our Stolen Future.

Over the years, people in environmental health questioned Doll's numbers, yet he was considered the pillar of respectability, and his results and opinion were bandied about with great authority by anyone wanting to downplay environmental links to our health. Three environmental health researchers decided to do some digging to see if Doll's numbers stood up to scrutiny. Richard Clapp, Molly Jacobs, and Genevieve Howe plunged into a literature survey, reading all the published studies and reports they could find. Their 2005 conclusion: "Environmental and occupational contributions to cancer in the U.S. are substantial and justify continued efforts to prevent these types of exposures."

This year, Clapp, Jacobs, and researcher Edward Loechler, revisited the earlier report, Environmental and Occupational Causes of Cancer, A Review of Recent Scientific Literature, studying over one hundred papers and reports that have seen print since their first review. What did they find? Unfortunately, nothing unexpected: The evidence is stronger than ever for a link between many exposures we face with some regularity and cancer, such as:

breast cancer to DDT exposure, particularly before puberty;

brain cancer from nonionizing radiation, particularly from radiofrequency fields emitted by mobile telephones;

non-Hodgkin's lymphoma from exposure to pesticides and solvents;

lung cancer from bad air days (pollution);

and, prostate cancer from exposure to pesticides, polyaromatic hydrocarbons (PAHs), and metal working fluids or mineral oils.

In this year's report, the authors come out forcefully. Perhaps, surprisingly so. Remember, scientists are trained to avoid opinionated conclusions, to remain comfortable in the sanctuary of their numbers and their peer-reviewed publications. Yet Clapp, Jacobs, and Loechler concluded this year's report with this:

We consider the scientific literature linking environmental and occupational exposures to cancer to be substantial and getting stronger as time goes on. One of us (R.Clapp) has been reviewing this literature for over thirty years. In the 1970s there were approximately a dozen substances or exposures that were considered “established” human carcinogens by international agencies. That number now approaches 100, with many more considered “likely” to cause cancer in humans. As we noted in our previous review, incidence rates for many types of cancer in the U.S. continue to rise, although we welcome the apparent decline in lung cancer in males and soon in females. The cancer burden, defined as the number of people living with cancer, with the attendant economic and human costs, will inevitably continue to grow.

This justifies urgent action to limit exposures to avoidable environmental and occupational carcinogens and to find safer alternatives to present chemical and physical risks. To repeat the call of ecologist Sandra Steingraber, “From the right to know and the duty to inquire flows the obligation to act.”

The report can be downloaded here.

Cough Syrups and Kids: They Aren't Just Small Adults

I was reading an article on the New York Times website this afternoon. The essence of the article, 'Parents Warned Cough Syrups Imperil Infants,' discusses a Food and Drug Administration advisory issued yesterday. The FDA's website, says that in October the Nonprescription Drugs Advisory Committee will discuss the safety and effectiveness of cough and cold products for children. In particular, it says, "Questions have been raised about the safety of these products and whether the benefits justify any potential risks from the use of these products in children, especially in children under 2 years of age." (For parents and grandparents, it's definitely worth going to this site yourself, as FDA has an important statement on, "What should parents know about using cough and cold products in children?)

Back to the NYT article. The writer, Gardiner Harris, says,

"[T]he standards for drug approvals have changed sharply in the decades since many of the medicines in children’s cough and cold products were approved. If those drugs were currently up for review, they would not be approved for use in children because the manufacturers never tested them thoroughly in children.

Instead, the drugs’ makers performed studies in adults and then simply assumed that they would work in children. Such assumptions, once common, are no longer acceptable. Indeed, a growing number of studies in children suggest that cough and cold medicines work no better than placebos."

Harris' statement highlights something I've come to understand from my research into environmental health: "children are not just small adults,", a statement that researchers and physicians at the forefront of this topic make quite frequently. A growing number of their studies show that all kinds of exposures that would be inconsequential for adults have profoundly negative impacts on kids. Because they are going through frenetic development their bodies react differently to chemical exposures than an adult's would to the same exposure.

Children are generally the most vulnerable to exposures, so we need risk assessments that focus on them.