This week in the magazine, Jerome Groopman writes about toxicity and everyday plastics. Today, Groopman answered readers’ questions in a live chat. A transcript of their discussion follows.
JEROME GROOPMAN: Good afternoon. I am looking forward to the chat.
QUESTION FROM GUEST: I work with Public Health Law Research, an organization that promotes research into what public health laws and policies actually improve people’s health. But most laws and policies in the U.S., including public health matters, are written with a political purpose, not a practical one. Do you think there’s any hope that we might bring science into policy-making?
JEROME GROOPMAN: I believe we have an opportunity here to integrate science into policy making in two ways. First, experts will designate sound scientific criteria for judging possible toxic effects of chemicals as part of the proposed legislation discussed in the article. Second, we can draw on science in terms of risk assessment, specifically assessing the probability that our judgments are correct, and the level of potential error.
QUESTION FROM PATRICK: Are we over or under reacting to the plastics concerns. I remember throwing out all my Nalgene bottles because of reports saying they were dangerous, only to hear that that wasn’t the case.
JEROME GROOPMAN: As the current research stands, there is genuine uncertainty about the level of risk from such plastics. There are studies in rodents that have conflicting outcomes, some indicating risk and others not. The data from cohorts of people are just emerging. In the face of such uncertainty, those who might be at the greatest risk, like pregnant women and children, could prudently avoid such plastics. For adults, other than pregnant women, it becomes more of a personal choice given the inconclusive data. But at the least the public should be aware of what chemicals are in the products they are using. This way, they can make the decision with that level of information.
QUESTION FROM MANUEL: What about bringing the precautionary principle into policy? Why do citizens need to proof that chemicals are damaging to our health? It should be the opposite. If there is a risk, those that will make a profit should encourage thourough independent research that demonstrates safety. What do you say to that?
JEROME GROOPMAN: The new legislation should do exactly that, put the burden on the manufacturer. This is why the current law is flawed. Absolutely there should be real attention to risk. On the other hand, we have independent researchers who are not sympathetic to the chemical industry who have failed to find toxic effects from BPA. As I said in the article, there needs to be new law and a shift of responsibility, but we also need to evaluate the quality of the science generated by all involved and be reasonably confident of the results.
QUESTION FROM MANUEL: Looks to me that without transparency in plastic formulations and without precautionary principle we are condemned to play whack-a-mole with toxic chemicals. Now we have more BPA-free plastics, but whet is BPA being replaced with? What about BPAF, which is even worse? Antimony? Wouldn’t you agree?
JEROME GROOPMAN: There is no disagreement here. At the end of the article is a call for safer alternatives. There should be absolute transparency.
QUESTION FROM BOB JOHNSON: One thing you didn’t highlight in your story was the potential risks of substitute chemicals. Congress has placed restrictions on certain phthalates that have been studied and proven safe by government agencies. However, the alternative plasticizers are less-studied and could hold unknown risks. How do we know that precautionary regulations on these chemicals won’t pose unintended consequences?
JEROME GROOPMAN: For sure, there needs to be the same safety criteria applied to those chemicals that are banned or restricted and those that serve as substitutes.
QUESTION FROM SARAH: Regulations thus far have focused on individual chemicals; I am wondering how regulations could address the potential effects of exposure to mixtures of chemicals. Even if the exposure levels are low enough for individual chemicals to not show effects of harm, some (animal) studies are finding that in combination, there may be effects.
JEROME GROOPMAN: This is very important and difficult question. Dr. Linda Birnbaum at NIH has initiated a program to evaluate combinations of chemicals in what are called “high throughput assays.” Here, one can test many combinations and begin to get data. Based on this initial screen, further testing can be done in animals. As you say, there are already studies indicating combinations should be evaluated in this fashion.
QUESTION FROM GUEST: Should individuals adopt a different level of risk assessment than states? In terms of plastics, I’m willing to hand-wash all my plastic containers, even if the federal government isn’t sure it has enough evidence to ban them.
JEROME GROOPMAN: This issue is not going to be definitively settled for the near future. All of us will be confronting uncertainty. I believe each individual can take steps to be more or less precautionary. He or she may be proven right in the future. That is not to say government or regulators should be lax.
QUESTION FROM KIM: While your article discusses scientific studies with different conclusions about the toxicity of various chemicals, an area not addressed is the funding source for these studies. The Milwaukee Journal Sentinel, for example, revealed that the FDA relied only on a small handful of industry funded studies to conclude BPA is safe. Only after this was brought to light did they begin the process of reassessing BPA. I think this is an important part of the issue that is missing and warrants examination.
JEROME GROOPMAN: I pointed out that the NIH panel did review several hundred studies with Vanderbergh and raised some concern. All federal agencies should rely on the best science. I believe the point you raise has prompted efforts to both standardize the scientific evaluation and make sure it is independent going forward.
QUESTION FROM STEPHENIE HENDRICKS: Denmark, France, Canada, all restricting BPA, and now the European Food Safety Authority re-evaluating it—don’t you think there is a bigger story of corporate integrity failure in the U.S.—like Wall Street regulatory failure, only in this case—if you speak with physicians—people are getting sick from endocrine disrupting effects linked to these chemical exposure. Why is this not told as part of the story?
JEROME GROOPMAN: There is real controversy in Europe, as pointed out in the article. Sometimes regulatory agencies ban chemicals that later prove safe. This was how the article opened. It is very difficult for individual physicians to conclude that someone’s illness comes directly from chemical exposure without a solid database from studies like the one at Columbia. Certainly I have seen patients where I suspected their cancer might have been related to a chemical exposure, but proof requires this kind of rigorous analysis. We have succeeded in the past with asbestos and benzene, for example, and by investing in good research will get the kind of science we need to better know risk.
QUESTION FROM DANIELLA: Is there a place for a labeling law that states what chemicals are used to produce the consumer product on the shelf. And list BPA, etc etc. If there is no conclusive evidence as you suggest, the industry should not object to that.
JEROME GROOPMAN: Absolutely. The consumer should be fully informed so that he or she can make an individual judgment about buying the product or not. We are moving towards this with foods and many people prefer organic products in their diets.
QUESTION FROM GUEST: In what ways does the issues of chemical exposure connect to economics, particularly class issues. In what ways are the urban poor more at risk? Or are all people, poor and wealthy, urban and rural at risk?
JEROME GROOPMAN: This is an excellent point. First, there is much more pollution in urban and poor areas. The Columbia study enrolled people from the neighborhood and the air samples showed this. But people in farm areas may be exposed to pesticides that are banned for home use but allowed in crops. In addition, richer people may have the means to purchase organic foods and certain products free of potential toxins while this is a terrible hardship for the poor.
QUESTION FROM SARAH: A challenge for epidemiological studies is, as you point out, the potential of epigenetic effects that can be passed down from one generation to the next. What if my child’s disease is in part due to my mother’s exposure when I was in utero? Measuring only my child’s exposures may not be adequate to determine cause and effect. Perhaps newer areas such as toxicogenomics can help elucidate cause and effect; I don’t know if this is the case yet, or if newer regulations might utilize these various other scientific approaches.
JEROME GROOPMAN: The science is indeed complex and I agree that we should invest in new research that can better characterize effects of toxins on the genome. I know that this is a priority with the proposed legislation from Congresswoman Slaughter of New York, who was originally a microbiologist before entering Congress. She is mentioned in the article and her proposal should be supported.
QUESTION FROM GUEST: Do you think that if by not restricting BPA millions of people have access to cheaper and more convenient products, and (for the sake of argument I’m just making these numbers up) tens of thousands of canned food related illnesses are prevented, while 50 people become sick from the plasticizer, we, as a society, should agree that this is an acceptable cost/benefit ratio? Do you think we need to educate the public to understand that such decisions are made all the time, and that there is no such thing as zero risk? Who should decide the level of acceptable non-zero risk? Industry? Domain experts? FDA? Public vote?
JEROME GROOPMAN: There are always potential tradeoffs as you point out. But to accurately assess those tradeoffs and to judge risk management for individuals and society, we need very sound science. That science is only emerging now. We should be very ready to inform the public and to calculate such risk/benefit as information evolves.
QUESTION FROM GUEST: It seems like there are strong links between pesticides and certain illnesses. But it’s harder for the average person to know the scope of their pesticide exposure. How can people effectively approach this issue?
JEROME GROOPMAN: All products used in the home to eradicate insects should be labelled and carefully assessed by the government regulatory agencies. As I pointed out, one had deleterious effects and was only banned in 2001. But the children exposed still had lingering effects. Foods also need to be judged with regards to pesticide contamination.
QUESTION FROM GUEST: Government regulators approve, for example, the MMR vaccine. That doesn’t mean that there aren’t occasional negative reactions to it. But opponents of childhood vaccines pounce on the fact that there are occasional negative reactions and say, “See! It isn’t safe.” They set up the scientist as a straw man. Government approval can’t ever “prove” the absolute safety of a practice or product, can it?
JEROME GROOPMAN: Nothing is ever 100% safe. But no one should demand absolute safety. On the other hand, we should not ignore potential risks, or fail to seek safer treatments and products when we have some body of data indicating potential toxicity.
QUESTION FROM JIM: Isn’t it true that scientists have had a difficult time repeating many of the laboratory studies on plasticizers that produced positive results for endocrine effects?
JEROME GROOPMAN: There are many conflicting laboratory studies in rodents. Professor Sharpe in Scotland who is very much concerned about environmental toxins recently also pointed out that results in rodents may not correspond to studies in monkeys, and of course humans are closer to monkeys in our evolution. That is why we can look at studies in animals but the emerging data on well characterized cohorts of people like at Columbia are so valuable in guiding our decisions.
QUESTION FROM GUEST: I like the questions from the chemical industry PR guy. They’re great.
JEROME GROOPMAN: I don’t know based on screen names who is submitting questions, but I am happy to engage everyone in the debate regardless of origin or bias. This should be a combination of solid science with our values as a society to protect as best we can, particularly vulnerable populations like pregnant women and infants.
QUESTION FROM STEPHENIE HENDRICKS: Sharpe’s studies were marmosets and it has been subsequently determined that marmoset endocrine systems are NOT similar to our own
JEROME GROOPMAN: But as you know, different species of rats will have different responses to the same chemical. We do not correspond exactly to any other species, but should be attentive to data that may be challenging.
QUESTION FROM STEPHENIE HENDRICKS: Why can’t we expect something to be absolutely safe? I think this is very, very dangerous thinking.
JEROME GROOPMAN: I believe in first do no harm, a principle of medicine since Hippocrates. But nothing can be absolutely safe because each of us has the potential to react differently. For example, sunlight is very important in generating sufficient vitamin D in our bodies, but exposure to sunlight can trigger skin cancer. We aim for moderation, but as Dr. Birnbaum said in the article, each of us has a unique physiology. We take what we hope are prudent risks every time we take a medication, believing that its benefit outweighs its risks. Not taking the pill might mean allowing an infection to spread; taking the antibiotic will potentially kill the microbe but comes with risk.
Thank you. I am signing off. I believe we have had very spirited and meaningful questions.