Toxics: now and forever

Cathey Eisner Falvo, MD, MPHPresident, International Society of Doctors for the

Environment representing Physicians for Social Responsibility

Cooper Hospital, April 27, 2011

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

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”**

Environmental causes of ill-health

• Injury-motor vehicles, sports, • Industry-factories, agriculture, power

sources• Fires • Buildings

WISQARST

M

P

r

o

d

u

c

e

d

B

y

:

O

f

f

i

c

e

o

f

S

t

a

t

i

s

t

i

c

s

a

n

d

P

r

o

g

r

a

m

m

i

n

g

,

N

a

t

i

o

n

a

l

C

e

n

t

e

r

f

o

r

I

n

j

u

r

y

P

r

e

v

e

n

t

i

o

n

a

n

d

C

o

n

t

r

o

l

,

C

e

n

t

e

r

s

f

o

r

D

i

s

e

a

s

e

C

o

n

t

r

o

l

a

n

d

P

r

e

v

e

n

t

i

o

n

Data Source: National Center for Health Statistics (NCHS), National Vital Statistics System

WISQARST

M

P

r

o

d

u

c

e

d

B

y

:

O

f

f

i

c

e

o

f

S

t

a

t

i

s

t

i

c

s

a

n

d

P

r

o

g

r

a

m

m

i

n

g

,

N

a

t

i

o

n

a

l

C

e

n

t

e

r

f

o

r

I

n

j

u

r

y

P

r

e

v

e

n

t

i

o

n

a

n

d

C

o

n

t

r

o

l

,

C

e

n

t

e

r

s

f

o

r

D

i

s

e

a

s

e

C

o

n

t

r

o

l

a

n

d

P

r

e

v

e

n

t

i

o

n

Data Source: National Center for Health Statistics (NCHS), National Vital Statistics System

10 Leading Causes of Death, United States2007, All Races, Both Sexes bases on CDC data

WISQARST

M

P

r

o

d

u

c

e

d

B

y

:

O

f

f

i

c

e

o

f

S

t

a

t

i

s

t

i

c

s

a

n

d

P

r

o

g

r

a

m

m

i

n

g

,

N

a

t

i

o

n

a

l

C

e

n

t

e

r

f

o

r

I

n

j

u

r

y

P

r

e

v

e

n

t

i

o

n

a

n

d

C

o

n

t

r

o

l

,

C

e

n

t

e

r

s

f

o

r

D

i

s

e

a

s

e

C

o

n

t

r

o

l

a

n

d

P

r

e

v

e

n

t

i

o

n

Data Source: National Center for Health Statistics (NCHS), National Vital Statistics System

1-4 5-9 10-14 15-19 20-24 Unintentional

Injury 1,588

UnintentionalInjury 965

UnintentionalInjury 1,229

UnintentionalInjury 6,493

UnintentionalInjury 9,404

CongenitalAnomalies

546

MalignantNeoplasms

480

MalignantNeoplasms

479

Homicide 2,224

Homicide 3,327

Homicide 398

CongenitalAnomalies

196

Homicide 213

Suicide 1,481

Suicide 2,659

MalignantNeoplasms

364

Homicide 133

Suicide 180

MalignantNeoplasms

673

MalignantNeoplasms

980

HeartDisease

173

HeartDisease

110

CongenitalAnomalies

178

HeartDisease

346

HeartDisease

738

Influenza& Pneumonia

109

Chronic Low.Respiratory

Disease 54

HeartDisease

131

CongenitalAnomalies

191

CongenitalAnomalies

211

Septicemia 78

Influenza& Pneumonia

48

Chronic Low.Respiratory

Disease 64

Cerebro-vascular

71

HIV 127

Mechanisms of exposure

• Inutero via the placenta• Breast (or bottle) milk• Air• Water• Soil• Food

POPS IN BREAST MILKAn example on the efficacy of

interventions

Solomon, 2002

Dieldrin in breast milk – Sweden

DDT in breast milk – Sweden

PBDE in breast milk – Sweden

Toxic body burden• Flame Retardants: PBDEs

• Chemical Specimin CF Study Max Study Min CDC 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

WHAT ARE "POPs" ? Synthetic organic chemicalsPersistent in environment Long-range transport leads to global pollution Lipophilic Accumulate in food-chainHigh levels in fish and marine mammals

Acute toxicity well-characterizedAcute toxicity well-characterized

NOAA

PESTICIDESAldrin

DieldrinChlordane

DDTEndrin

HeptachlorMirex

Toxaphene

INDUSTRIAL CHEMICALS

PCBsHCB

UNINTENDED BY-PRODUCTS

DibenzodioxinsDibenzofurans

PERSISTENT ORGANIC POLLUTANTS (POPs)

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

POPs IN THE ENVIRONMENT

AIR

IndustryWasteTraffic

Agriculture

WATER

LAND DEPOSITI

ON

Long-range transport

WATER &SEDIMENTDEPOSITION

• Air-water • Rain• Snow• Particles

SOURCES

FOOD CHAINFOOD CHAIN

Big fishBig fishMarine Marine mammalsmammals

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

Health effects –Hg

• Central nervous system– sever damage with coma and death– learning disabilities-attention deficit– hearing loss– tremors

Mercury (Hg)

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

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

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

Mercury-environ. source 2

• Light switches• Cosmetics• Pharmaceuticals and folk remedies• Batteries• Lamps and light bulbs

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)

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

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

Children represent the Children represent the future of nations.future of nations.

They need cleaner, safer and They need cleaner, safer and healthier environments – healthier environments – free free of POPs and other pollutants.of POPs and other pollutants.

Clean environments and Clean environments and education will enable children education will enable children to reach their full potential as to reach their full potential as individuals, individuals, as contributing members of as contributing members of society and as pillars for society and as pillars for sustainable development sustainable development

WHO

Thank you

Questions ?

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

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