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Plastics and Human Health O regon P hysicians for S ocial R esponsibility

Plastics and Human Health O regon P hysicians for S ocial R esponsibility. http://www.flickr.com/photos/kfisto/364229989/. Introduction. Overview. Chemical background: Current knowledge and regulatory policies Complex Interactions and vulnerability Review of familiar plastics

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Plastics and Human Health O regon P hysicians for S ocial R esponsibility

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  1. Plastics and Human HealthOregonPhysicians for Social Responsibility http://www.flickr.com/photos/kfisto/364229989/

  2. Introduction Overview • Chemical background: • Current knowledge and regulatory policies • Complex Interactions and vulnerability • Review of familiar plastics • Concerns: • Endocrine disruptors • Dose response patterns • Bisphenol A • Phthalates • What you and your patients can do

  3. Introduction

  4. Precautionary Principle Introduction “When an activity raises threats of harm to human health or the environment, precautionary measures should be takeneven if some cause and effect relationships are not fully established scientifically.” Wingspread Conference, 1998 Image: http://www.flickr.com/photos/tkneen/319265454/

  5. Toxic Iceberg Introduction Proven Harm Partially Proven Harm Not Yet Recognized Harm Forever Unrecognized Harm http://www.flickr.com/photos/greenpeace_italia/2165953486/

  6. Our Chemical Environment: Regulatory Control in the U.S. Introduction • More than 82,000 in U.S. commerce • 2,800 produced/imported >1mill. lbs/yr • Almost 4.25 billion pounds of toxic chemicals are reported to the EPA as released into the environment each year (TRI)

  7. Hazard Data for Chemicals Produced in Excess of 1 Million lbs/yr Introduction 7% Full* Set of Basic Information US E.P.A. (1998) Chemical Hazard Data Availability Study: What Do We Really Know About the Safety of High Production Volume Chemicals?

  8. http://www.flickr.com/photos/ylvas/1463679843/ Historical Perspective Introduction • 1920s: many new chemicals in industry • 1940s and 50s: new chemical innovations for the home • Exposure of developing fetuses • 1960’s: first data associating synthetic chemicals and health impacts • 1976: first over-arching chemical legislation enacted • Now: no changes have been made to the legislation…

  9. Complex Interactions Genetics Nutrition http://www.flickr.com/photos/thedepartment/86781504/ Social Environment http://www.flickr.com/photos/gonzales2010/9639815/ http://www.flickr.com/photos/lab2112/2036013217/ http://www.flickr.com/photos/calliope/130384035/ http://www.flickr.com/photos/celinesphotographer/383275778/ Introduction Toxic Exposures Health Outcomes

  10. Children are More Vulnerable Introduction • Organs are immature and developing • Brain & blood/brain barrier in infants • Developing immune system • Liver and kidney less efficient • Skin is more permeable, 2x surface area of adults • Greater exposure • Ingest more per pound • More surface area/weight in lungs and intestines • More contaminants dwell close to ground • Hand/mouth behaviors http://www.flickr.com/photos/johnmueller/342618825/

  11. Important Considerations • Evaluation of risk is inadequate: • Concurrent exposures to multiple chemicals: • Additive and synergistic effects • Only single chemical testing • Timing and dose of exposures • Interpretation of animal data • With increasing scientific understanding, we often find greater toxicity at lower levels of exposure

  12. Types of Plastics

  13. Plastics As We Know Them:Safer vs. Not-So-Safe Plastics 1 - polyethylene terephthalate (new evidence) 2 - high density polyethylene 3 - polyvinyl chloride 4 - low density polyethylene 5 - polypropylene 6 - polystyrene 7 - other (often polycarbonate)

  14. #1 - Polyethylene Terephthalate Food & beverage containers Single-use water bottles Microwave food trays Food packaging films Clothing Polyester, polar fleece Plastics http://www.flickr.com/photos/brimelow/73092271/ Use one time, avoid heating or long-term storage http://www.flickr.com/photos/caobhin/194534255/

  15. #2 - High Density Polyethylene Opaque bottles Milk jugs Detergent bottles Gas tanks Pipes and tubing Plastic Lumber Plastic bags http://www.flickr.com/photos/fservayge/1472436308/ Plastics http://www.flickr.com/photos/splorp/9322376/ http://www.flickr.com/photos/tzofia/291301033/ http://www.flickr.com/photos/adamcnelson/2262436767/

  16. #3 - Polyvinyl Chloride (PVC) Teething rings Pacifiers Toys (inflatable) Pipes, Tubing Medical equipment Shower curtains Clothing Synthetic leather Window frames Siding Plastics http://www.flickr.com/photos/sisterdimension/540271784/ http://www.flickr.com/photos/ryosalem/227010700/ http://www.flickr.com/photos/artventuresgallery/184264587/ Major health concerns – avoid and replace

  17. #4 – Low Density Polyethylene Plastic wraps Flexible bottles Plastic baggies Flexible tubing Furniture Dental appliances Lab pipettes and tips http://www.flickr.com/photos/ingorrr/1353394390/ Plastics http://www.flickr.com/photos/unprose/154829034/ http://www.flickr.com/photos/sonnyandsandy/33707441/

  18. #5 - Polypropylene Trays Food storage containers Some baby bottles http://www.flickr.com/photos/dearbarbz365/2252998299/ http://www.flickr.com/photos/jdickert/2383258186/ Plastics http://www.flickr.com/photos/seandreilinger/2450683425/

  19. #6 - Polystyrene Clear food containers Styrofoam food trays Disposable cups, bowls Packaging material Insulation Coolers Lab equipment Plastics http://www.flickr.com/photos/mr_enigma/62914044/ http://www.flickr.com/photos/tychay/1535108294/ http://www.flickr.com/photos/crouchingdonkey/1162561710/ http://www.flickr.com/photos/keuynish/163686563/

  20. #7 “Other” - often Polycarbonate Some baby bottles Reusable drink bottles Lining of food cans Cutlery Food dishes, containers Dental fillings, sealants Eyeglass lenses Compact Discs http://www.flickr.com/photos/darrylh/505340977/ http://www.flickr.com/photos/miss-frugality/403374907/ Plastics http://www.flickr.com/photos/iwantamonkey/127501910/ http://www.flickr.com/photos/ngtj/551390741/ http://www.flickr.com/photos/reuvenim/2523549479/

  21. Pros and Cons of Plastics Benefits: • Current technology and lifestyle • Medical, sanitary • Construction, transportation • Information transfer Adverse effects: • Environment and other organisms • Human Health Impacts • Bisphenol-A and Phthalates

  22. Health Concerns

  23. Endocrine Disruptors • May adversely affect: • Development • Reproduction • Nervous function • Immune function • Greater risk for fetuses and young children Bisphenol A and Phthalates are examples found in plastics

  24. Action of Endocrine Disruptors Health • Mimic estrogen, androgens, progesterone • Block hormones by binding to receptors • Interfere with endocrine signaling paths • Interfere with thyroid • Researchers expect that more effects will be found.

  25. Other Endocrine Disruptors Health • DES (diethylstilbestrol) • Dioxin and dioxin-like compounds • Polychlorinated biphenyls (PCBs) • DDT and other pesticides • Hormone-containing pharmaceuticals

  26. Low Dose Health • Historical Reference Doses for toxicity: • Bisphenol A (BPA): 50 μg/kg/day* • Phthalates: DEHP: 20μg/kg/day DBP: 100 μg/kg/day DEP: 800μg/kg/day • Studies show adverse effects at much lower doses • parts per trillion for some effects of BPA *μg/kg/day = parts per billion (ppb)

  27. Different from traditional dose-response curve U-shaped and inverted U-shaped Lowdoses can stimulate response, high can inhibit Many endocrine disruptors have non-monotonic curves Non-monotonic Dose Response Curve Health http://www.environmentalhealthnews.org/sciencebackground/2007/2007-0415nmdrc.html http://www.environmentalhealthnews.org/sciencebackground/2007/2007-0415nmdrc.html

  28. Potential Effects of Endocrine Disruption Health • Falling age of puberty in girls • Increasing rates of obesity and diabetes • Male genital abnormalities • Regional decreases in sperm count • Increasing rates of endocrine-related cancers • breast, prostate • Increasing rates of neurobehavioral problems: autism, hyperactivity

  29. Bisphenol A

  30. Bisphenol A (BPA) • What we know • Health Concerns and exposure • Consensus Statements • Action to regulate • What can be done

  31. Bisphenol A: What We Know BPA • Backbone of Polycarbonate plastic • Resin code: #7 (other) • Known since 1930s to be estrogenic • Mechanism of action • Binds to both nuclear and cell membrane receptors • Rapidly metabolized and cleared • Human exposure is continuous • High volume chemical: >6 billion pounds per year Center for the Evaluation of Risks to Human Reproduction

  32. http://www.flickr.com/photos/bframe/406051181/ Bisphenol A: Health Concerns BPA • Reproductive effects-male and female • Insulin resistance, diabetes & obesity • Altered brain development • Cancer • Prostate • Breast • Decreased antioxidant enzymes • Recurrent miscarriages • Altered immune function • Behavioral effects • Alters attention, activity

  33. http://www.flickr.com/photos/diarmada/1310673668/ Human BPA Exposure BPA • BPA in 95% of US population (CDC) • Widespread use = widespread exposure • Concentrations in humans similar to levels causing harm in animals

  34. Sources of BPA Exposure BPA • Food and drink containers are primary source • Leaching: • Into water at room temperature • With heating • With repeated washing of material • With acidic or basic foods/liquids • Maternal exposure • Breast milk • Prenatal exposure • Indoor & outdoor air • Dialysis tubing

  35. Literature regarding BPA BPA • 115 published in vivo studies of low-dose BPA effects • “Significant” effects in 94 • 90% of government-funded studies found adverse effects • 0% of industry-funded studies found adverse effects

  36. National Toxicology Program, April 2008 First government acknowledgement of possible harm Controversy over evaluation of existing data Panel chosen for lack of expertise Chapel Hill Consensus Statement, November 2007 Response to NTP assessment 38 BPA experts Reviewed published BPA literature to date Two Recent Statements on BPA

  37. National Toxicology Program, April 2008 First government acknowledgement of possible harm Controversy over evaluation of existing data Panel chosen for lack of expertise Findings: “some concern…” “the possibility that bisphenol A may alter human development cannot be dismissed.” Two Recent Statements on BPA Chapel Hill Consensus Statement, November 2007 • Response to NTP assessment • 38 BPA experts • Reviewed published BPA literature to date • Findings: • Non-monotonic dose-response curves • Concentrations in humans similar to levels causing harm in animals • Sensitivity to BPA varies with life stage

  38. Recent BPA Decisions BPA • December 2006 • San Francisco ban • April 2008 • Canada labels BPA as “dangerous substance” • Nalgene will stop using BPA in bottles • Wal-Mart and Toys-R-Us will stop carrying products w/ BPA

  39. What You Can Do About BPA • Avoid canned foods and drinks • Use alternatives to #7 baby bottles: • Breast feed, glass bottles • Use alternative sippy cups: • #2,4,5, stainless steel • Use alternatives to polycarbonate for storing food and water: • glass, ceramic, safer plastics: #2,4, 5 • Never heat/cook/microwave food in any plastic

  40. Phthalates

  41. Phthalates • What we know • Health Concerns and exposure • Reproductive Health Concerns • Regulations • What you and your patients can do

  42. Phthalates: What We Know Phthalates • Large class of chemicals • Large molecules like DEHP make vinyl (PVC) flexible and durable • Smaller molecules (DEP, DBP, DMP) are found in perfumes, lotions, cosmetics, and time-release medications DEHP:http://cerhr.niehs.nih.gov/chemicals/dehp/dehp.html DEHP = di(2-ethylhexyl) phthalate DEP = diethyl phthalate DBP = dibutyl phthalate DMP = dimethyl phthalate

  43. Sources of Exposure to Phthalates Phthalates • 1 billion pounds produced annually worldwide • 2000: CDC found high levels of phthalates in Americans • Women of child-bearing age had highest levels • Found in blood, urine, breast milk, amniotic fluid • A ubiquitous contaminant • Found in air, soil, water, sediment

  44. Phthalates in Consumer Products Phthalates • Vinyl plastic (PVC) • Toys, inflatable mattresses • Fragrance • Soap, lotion, detergent, air fresheners, etc. • Other common products: • Paint • Adhesives • Car interiors • Wood finishes • Detergents • Solvents • Shower Curtains http://www.flickr.com/photos/desiitaly/2254327579/

  45. Phthalates in Medicine Phthalates • Tubing • IV bags • Gloves • Bags containing plasma • Time-released drugs • http://www.flickr.com/photos/59334544@N00/2322167178/

  46. Exposure Issues with Phthalates Phthalates • People exposed to many simultaneously • 84% exposed to 6+ at the same time • Multiple exposures not considered when EPA determines safe dose • Different phthalates have the same mechanism of action • Effect is additive

  47. Phthalates Toxicity Phthalates • Degree of toxicity related to: • Metabolites (different from parent compounds) • Route of exposure: • Inhalation, ingestion, injection, dermal • Age at exposure

  48. Phthalates: Health Concerns Phthalates • Endocrine system • Thyroid • Insulin resistance • Obesity • Diabetes • Male reproductive problems • Allergies, asthma

  49. Phthalates Phthalates: Potential Reproductive Effects • High dose and low dose risk • Early puberty in females • Male reproductive effects: • Lowered semen quality • Testes (Leydig) cells vulnerable • Reproductive effects in infants • Swan, et al. (2005) study on male infants: • Urine levels of mothers’ phthalate metabolites postive correlation with shorter ano-genital distance (AGD) http://www.flickr.com/photos/nirak/206930221/

  50. Phthalates: Reproductive Effects Phthalates • Swan, et al., 2005 - Human male infants: • 85 mother-son pairs • Measured 9 phthalate metabolites in prenatal urine samples • Examined Ano-Genital Distance (AGD) in newborn males (5-16 mo) • Urine levels of 4 metabolites inversely correlated w/ AGD • Shorter AGD increased risk of undescended testes, smaller penis size, and small scrotum

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