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Toxics: now and forever

Toxics: now and forever. Cathey Eisner Falvo, MD, MPH President, International Society of Doctors for the Environment representing Physicians for Social Responsibility Cooper Hospital, April 27, 2011. Learning objectives.

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Toxics: now and forever

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  1. Toxics: now and forever Cathey Eisner Falvo, MD, MPH President, International Society of Doctors for the Environment representing Physicians for Social Responsibility Cooper Hospital, April 27, 2011

  2. Learning objectives • Understand the burden of pediatric disease from environmental pollution • Know some of the leading environmental pollutants in your area • Understand the need for an environmental history as part of the pediatric visit • Have some tools for helping your patients avoid environmental toxic exposure

  3. WHO • 24% disease burden in the world is from environmental exposures* • “About 3 million children under five die annually from largely preventable environment-related causes”**

  4. Environmental causes of ill-health • Injury-motor vehicles, sports, • Industry-factories, agriculture, power sources • Fires • Buildings

  5. 10 Leading Causes of Death, United States2007, All Races, Both Sexesbases on CDC data

  6. Mechanisms of exposure • Inutero via the placenta • Breast (or bottle) milk • Air • Water • Soil • Food

  7. POPS IN BREAST MILKAn example on the efficacy of interventions Dieldrin in breast milk – Sweden DDT in breast milk – Sweden PBDE in breast milk – Sweden Solomon, 2002

  8. Toxic body burden • Flame Retardants: PBDEs • ChemicalSpeciminCFStudy MaxStudy MinCDC 50th %95th % • DiBDE BDE-15 serum pg/g 158 486 90.5 • TriBDE BDE-28 serum pg/g 1170 5560 91.1 1100 7900 • TriBDE BDE-37 serum pg/g u 55. u • TetraBDE BDE-47 serum pg/g 8680 109000 738 19200 157000 • TetraBDE BDE-51 serum pg/g u 89.4 u • TetraBDE BDE-79 serum pg/g 28.1 245 u • PentaBDE BDE-99 serum pg/g 1790 24200 595 <LOD 42200 • HexaBDE BDE-138 serum pg/g 55.4 369 u • HexaBDE BDE-153 serum pg/g 3110 20900 98 4800 65700 • HeptaBDE BDE-190 serum pg/g u 151 u • OctaBDE BDE-203 serum pg/g 165 295 67.5 • NonaBDE BDE-207 serum pg/g 684 1040 427 • DecaBDE BDE-209 serum pg/g u 9040 u • Bisphenol A BPA Urine ng/mL 7.11 7.11 0.449 2.7 15.9 • Sanitizing Agent: Triclosan • Triclosan Urine ng/mL 60.3 214 U 9.2 459 • Phthalate Metabolites • Mono-ethyl Phthalate (DEP) • m-EtP urine ng/m 200 200 U 181 2720 • mono-2-ethylhexyl phthalate (DEHP) • m-EHP urine ng/mL 2.15 101 2.06 4.1 39.5 • Heavy Metals • Lead Pb serum µg/L U 31 U 16 52 • Mercury Hg serum µg/L 2.27 2.27 U 0.7 4.6

  9. WHAT ARE "POPs" ? • Synthetic organic chemicals • Persistent in environment • Long-range transport leads to global pollution • Lipophilic • Accumulate in food-chain • High levels in fish and marine mammals Acute toxicity well-characterized NOAA

  10. PERSISTENT ORGANIC POLLUTANTS (POPs) INDUSTRIAL CHEMICALS PCBs HCB PESTICIDES Aldrin Dieldrin Chlordane DDT Endrin Heptachlor Mirex Toxaphene UNINTENDED BY-PRODUCTS Dibenzodioxins Dibenzofurans Stockholm Convention: a global treaty ratified by the international community lead by UNEP – calls for the elimination and/or phasing out of 12 POPs www.chem.unep.ch/pops/default.html

  11. POPs IN THE ENVIRONMENT Long-range transport AIR • Air-water • Rain • Snow • Particles SOURCES Industry Waste Traffic Agriculture WATER WATER & SEDIMENT DEPOSITION LAND DEPOSITION FOOD CHAIN Big fish Marine mammals

  12. Triclosan • Soaps and sanitizers • Toothpaste • A wide variety of commercial antimicrobial use • incorporated in conveyor belts, fire hoses, dye bath vats, or ice-making equipment • commercial HVAC coils, adhesives, fabrics, vinyl, plastics (toys, toothbrushes), polyethylene, polyurethane, polypropylene, floor wax emulsions, textiles (footwear, clothing), caulking compounds, sealants, rubber, carpeting • An endocrince disrupter

  13. Health effects –Hg • Central nervous system • sever damage with coma and death • learning disabilities-attention deficit • hearing loss • tremors

  14. Mercury (Hg) • Three (3) forms • Hgo - elemental, quicksilver • Hg+, Hg++- salts • organic mercury-methyl, ethyl, phenyl

  15. Mercury cycle • Mercury can go from one form to another in the presence of bacteria, sunlight, and other catalysts • Mercury accumulates in the food chain • It deposits in muscle, not fat, of animals

  16. Mercury environmental sources • In rock, fossil fuel, and water - released into air as vapor • Industrial catalyst and solvent • Pesticides and fungicides • Food = fish • Various electronics-computer monitors

  17. Mercury-environ. source 2 • Light switches • Cosmetics • Pharmaceuticals and folk remedies • Batteries • Lamps and light bulbs

  18. A word about climate change • Burning fossil fuel is a major source of green house gases • Burning fossil fuel is a major cause of acute and chronic respiratory disease • Burning fossil fuel is a major source mercury • Burning trash is a major source of mercury, dioxin, arsenic, furans, etc (depending on what is burned)

  19. What can you and your patients do? • Ask as part of the patients history • Parents/patients occupational & hobby history • Neighborhood, including multifamily dwelling exposure • Reduce, reuse, recycle, compost • Read labels-plastics with #1, 2, 4 and 5 are safer • Only use “microwave safe” labeled containers in the microwave oven • Lock up chemicals (in original container) • No smoking/other fires in home • Keep car idling to a minimum and never in a closed space (garage) • Have smoke and carbon monoxide detectors in the home

  20. Action 2 • Wash hands after bathroom and before eating • Fishing? Check state advisory for contamination • Eat a variety of foods • TAKE ACTION in your community, and at the state and federal level Some contaminants are beyond you and your patients’ ability to control

  21. Children represent the future of nations. They need cleaner, safer and healthier environments – free of POPs and other pollutants. Clean environments and education will enable children to reach their full potential as individuals, as contributing members of society and as pillars for sustainable development WHO

  22. Thank you Questions ?

  23. Pediatric environmental health specialty units (PEHSU) • REGION 2Service area: New Jersey, New York, Puerto Rico, Virgin IslandsMount Sinai Pediatric EnvironmentalHealth Specialty UnitAcademic Affiliation Mount Sinai School of Medicine: Department of Pediatrics. Department of Community and Preventive MedicineHospital Affiliation: Mount Sinai Medical CenterLocation: New York, New Yorkwww.mssm.edu/cpm/pehsu/(212) 241-5756Toll Free (866) 265-6201E-mail pehsu@mountsinai.org> • REGION 3Service area: Delaware, Maryland, Pennsylvania, Virginia, Washington DC, West VirginiaMid-Atlantic Center for Children’s Health & the Environment Pediatric Environmental Health Specialty UnitAcademic Affiliation: George Washington University Hospital Affiliation: Children’s National Medical Center Location: Washington, DCwww.childrensnational.org/MACCHE(202) 471-4829 Toll Free (866) 622-2431E-mail: MACCHE@cnmc.org

  24. References and sites of use • http://ehp03.niehs.nih.gov/home.action • http://www.cdc.gov/asthma/healthcare.htm • http://www.cdc.gov/exposurereport/ • http://www.cdc.gov/Environmental/l

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