Transcript Slide 1

Slowly poisoned: health
consequences of pollution and
environmental toxins
Martin Donohoe, MD, FACP
Portland State University
Campaign for Safe Foods, Oregon
Physicians for Social Responsibility
Overview
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Public health approach
Air pollution
Garbage
Toxins
Education/Corporate Influence
Progress and Solutions
Some Major Sources of Air
Pollution
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Industry - #1
Agriculture
Automobiles
Indoor combustion of coal and
biomass for cooking, heating and
food preservation
Air Pollution
Air Pollution
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
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
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
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
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
Automobiles
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
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.
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)
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
Automobiles: Alternatives
• Rapid transit
• Electric cars
–killed by oil companies, automakers, tire
manufacturers in early 20th century
–Convicted under Sherman Antitrust Act
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
Automobiles: Alternatives
• Busses
• Trains
–15 x more efficient per passenger
than autos
• Natural gas and/or gasohol
-generate less CO2
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
Automobiles: Alternatives
• Solar cars
• Hydrogen-powered cars
–Byproduct = water
–Problem: Hydrogen production
requires fossil fuels
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”
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
Garbage
• In one year, Americans generate
236 million tons of garbage
–30% recycled
–164 million tons thrown away
U.S. Garbage Composition
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Paper and Paperboard - 39%
Yard Waste - 13%
Food Waste - 10%
Plastics - 10%
Metals - 8%
Glass - 6%
Wood - 5%
U.S. Recycling Rates
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Tires - 22%
Plastic containers - 36%
Glass containers - 28%
Yard waste - 41%
Paper and Paperboard - 42%
Aluminum packaging - 54%
Steel cans - 60%
Auto batteries - 93%
Garbage
• Landfills (2300 in US)
• Incinerators
• Garbage exports
Toxins
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
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
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
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
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
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
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
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
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
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
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
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
Pesticides
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
Lead
• 2 million US children with
elevated levels
• 120 million people with level >
10mcg/dL worldwide
• #s affected dropping
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
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
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
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
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
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
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
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
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
Persistent Organic Pollutants
• Toxic, remain in environment longterm, resist degradation, can travel
long distances
• Bioaccumulate - higher
concentrations as you move up
the food chain
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
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
Pesticides and Other Toxins Linked
to Neurological Disease
• Parkinson’s Disease
• Autism
• Others
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
Phthalates
• Associated with:
–demasculinization and alterations in
genitalia in male infants
–lower testosterone levels
–lower sperm counts in adults
Phthalates/PVCs and Medical
Devices
• EPA regulations weak, based on 50year old study
• FDA has advised healthcare
providers to use alternatives to
DEHP-containing PVC medical
devices, esp. in neonatal units
Environmental Racism
and 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
Mining and Pollution: Gold
• Cyanide “heap leach” gold
mining
–cyanide dripped over crushed
rock to extract gold
–taxpayers often stuck with
cleanup costs
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
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
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
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
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
Medical Waste
• Incinerated pollutants include dioxin,
mercury, cadmium and lead
• EPA regulations weak
• Segregation and alternatives to
incineration would cost 93
cents/patient/day
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)
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
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
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
Water Pollution:
Bathtub=Toilet=Source of Drinking Water
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, 15,00020,000 more over next 10 years; tens of
thousands injured
–persistent water and soil contamination
Minimata Disease
W Eugene Smith
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
Since Exxon Valdez
• At least 1.1 million tons of oil have
spilled from tankers worldwide
–Equivalent to 30 Valdez
incidents
Oil Pollution is Expensive to Clean
Up
Oil Slicks Kill Marine Life
The Military and Pollution
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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
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
The Military
• Small arms and rocket propelled
grenades
• Land mines
• Nuclear, chemical and biological
weapons
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
Worrisome Trends
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GATT
NAFTA
CAFTA
Other trade agreements
SLAPP/SLAPP-Back
• Strategic Lawsuits Against Private
Parties/ Countersuits
• SLAPPs- designed to harass
environmental groups, deplete their
financial resources through
threatened or actual litigation
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
Bush Administration
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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
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
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)
Pseudoscientific Beliefs
Percentage of Americans who believe
“at least to some degree” in these
“phenomena”
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Astrology
UFOs
Reincarnation
Fortune-Telling
1997
37%
30%
25%
14%
1976
17%
24%
9%
4%
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
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
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
Sponsored Environmental
Educational Materials
• Corporate-sponsored and
supported by a loose
coalition of antiregulatory
zealots, corporate polluters,
lapdog scientists and
misguided parents
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”
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”
“Doubt is our product”
Brown and Williamson Tobacco Company
Memo, 1960s
Progress and Solutions
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
Environmental Success Story
The 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
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
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)…..
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
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
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)
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
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
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
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
Solutions
Based 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”
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
The Precautionary Principle
• Endorsed by APHA, ANA, others
• Puerto Rico, San Francisco have
adopted, among others
• Big business, US Chamber of
Commerce oppose
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)
Contact Information
Public Health and Social Justice
Website
http://www.phsj.org
[email protected]