A Momentary Lapse of Reason?

An essay written by Dennis Perrin suggests that critical thinking is overrated, especially as practiced by the public intellectuals and other smart people around here. He argues that critical thought needs to occur within some distinct boundaries, if you want to remain relevant particularly within political and media circles:

To write for the New York Times, for example, you have to seriously believe that the United States is a force for Good in the world, sometimes mistaken, but always sincere. I've known or chatted up a smattering of Timespeople, and while privately they were some of the most cynical types I've ever met, none of their personal critiques would appear in the Times, simply because they'd never dare submit such nonsense. And these are supposedly the "smart ones," those who set the journalistic/critical/aesthetic standard.

An he's not terribly sanguine about things changing with the onset of the now-the-adults-are-here Obama administration. Though we seem to be on the precipice with environmental collapse, financial meltdown and a half of dozen other unpleasantries, he feels that "nothing substantial will change because too many people don't want substantial change" - and this is referring to educated people who presumably know better but are anxious to maintain whatever perks they enjoy:

Such degraded conditions are anathema to real critical thinking -- if anything, this inspires further devotion to the main narratives. Think all those reporters who've lost their jobs are gonna become an army of I. F. Stones? It's a nice idea, and if probable, I'd certainly champion it. But as you can see, there's no money or honor in such tawdry pursuits. If you want to eat using your words, become really good at selling shit. That's where critical minds are most needed.

Which doesn't bode well for our ability as a society to weather crises. NPR recently interviewed Jarred Diamond, author of Collapse, published back in 2005. Diamond concludes that a society’s fate in response to these crises is determined by how well its leaders and citizens anticipate problems before they become crises, and how decisively a society responds. In the NPR interview, he amplifies that one of the predictors of successfuly resolving a crisis is the role of the elite, the decision-makers, the politicians and/or the rich people within the society:

If the society is structured so that the decision-makers themselves suffer from the consequences of their decisions, then they're motivated to make decisions that are good for the whole society, whereas if the decision-makers can make decisions that insulate themselves from the rest of society, then they're likely to make decisions that are bad for the rest of society.

Uh-oh. We're so screwed, aren't we?

He observes that part of the foot-dragging in New Orleans about flood and disaster preparedness that led to the disaster following Hurricane Katrina occurred because the well-off people recognized that they lived on higher ground that wouldn't be flooded. In contrast, the Netherlands takes flood control more seriously because the rich folks are living below sea-level along with the proles.

So, if we're going to steer ourselves into making better choices, the rich and powerful need to feel more of the pain, so they become the agents of change.

Speaking of inability to feel pain and steer us in the right direction, the Senate is fighting the Obama Administration's plan to pass cap-and-trade legislation for greenhouse gas emissions. The opponents are bipartisan, and the dividing lines are betwen regions, depending on who's mining, generating or using a lot of coal-fired electricity. There isn't a lot of critical thinking going on here, since the longer we delay acting on climate changes, the slimmer our hopes are of resisting it.

Not that I think cap-and-trade is going to accomplish all that much in terms of addressing adverse climate change.

Even in places where you think paradigms whould be shifted, the critical thinking stays within its lanes. Worldchanging.com recently had a post about the spectrum of environmental thought, showcasing "bright green", "dark green" and "light green". It's interesting that Worldchanging offered no label for those who might be drawn to James Lovelock's pronouncements that planetary feedback mechanisms have been perturbed past a self-correcting point (i.e. we've killed Gaia), so that we're now the stewards of the Earth. Under this scenario, none of the shades of green offered here are meaningful environmental management strategies. No color scheme is offered for the combination of high technology projects for energy generation, transportation, agriculture and medicine, to hold civilization together while global geoengineering and bioenginering projects attempt to correct the climatic and biodiversity injuries we've created. What would that be, blue green?

I'm not confident that bright green will slow the trajectory of adverse changes in time, especially after reading the work of John Sterman at MIT (the "bathtub effect" guy). Dark green is Rapture for deep environmentalists; simply an invitation for death on a grand scale from war, disease and starvation. Light green is irrelevant on the scale of problems that need correcting.

Pres. Obama's stimulus package, as misguided as it is (particularly with spending on GM, the banks and fixing roads) at least gets people accustomed to spending money on a grand scale and to seeing something of the magnitude of the effort needed to turn this ship. It still needs to translate into the will to create the mother of all global scientific and engineering projects (one that makes the Manhattan Project and the Apollo Project combined look like entries at a junior high science fair) to make sure humanity has a future over the next few centuries.

Maybe I'm just not thinking critically enough about these matters.

Honest Brokers and Concern Trolls

While it’s not based on a systematic study, I get the sense that Roger Pielke, professor of environmental policy at the University of Colorado has been an annoyance to many environmentalists. See this somewhat contentious interview (which apparently was spiked, but which Pielke publishes here) with Brad Johnson with the Center for American Progress. At one point, Dr. Pielke makes allusions to McCarthyism in the interview process (you know, the “are you now or have you ever been a Communist” routine) which while a bit over the top, provided some amusement. I suppose it doesn’t help your environmentalist cred though to be interviewed by professional concern troll John Tierney.

Tierney complains that President Obama’s science advisors aren’t sciencey enough, and are injecting their personal agendas along with the science used to inform the government’s policy making. Not to put too fine a point on things, he asks, “[t]o borrow a term from Roger Pielke Jr.: Can these scientists be honest brokers?”

It’s possible I’m reading too much into this, but trust Tierney to take a reasoned analysis of the interactions of scientists in policy making (Pielke’s book, The Honest Broker: Making Sense of Science in Policy and Politics) and make it into an indictment of science policy for the administration in power:

A scientist can enter the fray by becoming an advocate for certain policies, like limits on carbon emissions or subsidies for wind power. That’s a perfectly legitimate role for scientists, as long as they acknowledge that they’re promoting their own agendas.

But too often, Dr. Pielke says, they pose as impartial experts pointing politicians to the only option that makes scientific sense. To bolster their case, they’re prone to exaggerate their expertise (like enumerating the catastrophes that would occur if their policies aren’t adopted), while denigrating their political opponents as “unqualified” or “unscientific.”

Ok, it’s time to stop the hyperventilating. Dr. Pielke’s book is actually a very useful guide for scientists about the kinds of options they have in advising decision makers, when given the opportunity. The nature of scientific advice will depend on how politicized the issue is (i.e. is there values consensus) and how much scientific uncertainty is present. Depending on the circumstances, one could adopt the stance of a Pure Scientist, summarizing the state of knowledge in a particular field, to help reduce uncertainty and inform a decision, but not engaging in the normative or values debates. When engaged to consider specific policy options, one might adopt the role of a Science Arbiter, similarly focusing on a technical role (framing the problem and presenting the state of knowledge) but again staying above the debate.

However, problems with no values consensus cannot be resolved by reducing scientific uncertainty (Pielke’s context for this is “abortion politics”). The scientist can then choose to help reduce the range of options by becoming an Issue Advocate, aligning with a particular political agenda. If a scientist seeks to expand the range of options to be considered, they can become Honest Brokers of Policy Alternatives, clarifying existing options and identifying new ones. As described in a book review published in the journal Minerva:

Honest Brokers explicitly integrate stakeholder concerns with available scientific knowledge. The former U.S. Office of Technology Assessment, for example, produced reports that identified a range of policy options and showed how they related to disagreements over both science and policy (pp. 17, 95). Interestingly, because Honest Brokers must draw on diverse perspectives to integrate scientific knowledge and policy options in context of uncertainty, they usually take the form of interdisciplinary advisory bodies rather than individual experts (pp. 151, 154-56).

Dr. Pielke views all four of these roles as appropriate, but cautions that issue advocacy should be done transparently, acknowledging political values rather than asserting that the scientist’s preferred policy flows directly from their scientific evidence. This becomes Stealth Issue Advocacy, which politicizes scientific advice and undermines the credibility of science in the eyes of the public.

Seen in this light, Tierney’s use of the term “honest broker” in discussing Steven Chu and John Holdren provokes in me an Inigo Montoya moment. After reading this column, I can only be glad that John Tierney isn’t interested in borrowing any of my ideas. In addition, keeping in mind that Dr. Pielke’s book was published in 2007, I wonder if it occurs to Tierney that it could be referring just as much to the war on science waged by the Bush Administration as to John Holdren’s role as a stealth issue advocate in criticizing Bjorn Lomborg.

Alternative Futures in a Post-Stimulus World

There’s an air of unreality surrounding this week’s passage of economic stimulus legislation. I suspect that many are expecting things to “get back to normal”, if we just fix the foreclosure crisis, get the banks lending again, and get consumers buying stuff again. In the mainstream media I sample, I don’t get a sense that with the economic downturn we’ve turned a corner to a considerably different future.

One vision of that future is the crash of our energy intensive way of life, with scenarios that range from a post-Peak Oil collapse (the progressive version of the Rapture) to a sort of post-industrial feudalism as envisioned in James Howard Kunstler’s The Long Emergency. In this future, the Amish may be the epitome of high technology.

There’s a Green crowd which feels that if you shout “no clean coal” loud enough, this and a lot of hard work will create a vision where life is much better by moving to cleaner production, mass transit and renewable energy. These are the kinds of investments that should be made, because building windmills, weatherizing buildings and restoring strip-mined mountaintops are more useful ways to create jobs than building freeways, but I’m no longer convinced this path alone is going to save us, particularly from adverse climate change. Take John Sterman’s greenhouse gas simulator for a spin and see. You have to drag emissions down quite a bit, very quickly, to have a meaningful impact. However, we’re having a hard time even getting started – people still seem to be confused about the imminence and magnitude of the risk, and long lead time needed to produce any changes, with a significant fraction taking a wait and see attitude on greenhouse gas reductions.

And, according to Dr. Sterman, even smart people are kind of clueless about stock and flow kinds of problems in general (look at the wishful thinking many people engage in when trying to manage their weight), misjudging how feedback loops work with climate change – it seems that people expect climate change to abate quickly once emissions are reduced. The most recent evidence suggests otherwise – we’re stuck with adverse climate change. The challenge is to keep from making it worse.

In contrast to the hunker-down philosophy of getting through the next few centuries (see The Long Emergency), James Lovelock argues in a new book that preserving civilization in the face of adverse climate change will require a massive infusion of high technology. This is seemingly contrary advice from the author of the Gaia hypothesis, but it really is consistent with his message that we’ve now made ourselves stewards of the Earth – wish us luck. You can argue over the details (I think he overstates the effectiveness of nuclear power) but he does make me wonder if the Green crowd is thinking hard enough about what it takes to save us as a species.

This wanders away a bit from the economic stimulus package, but we shouldn’t fool ourselves about what it’s accomplishing. The economic stimulus is really focused on trying to regain our past rather than take us into the future, and the consequences of that choice aren’t pleasant to contemplate.

PFOA Toxic Torts and the Future of Risk Assessment

Perfluorooctanoic acid (PFOA) has been used used to manufacture Teflon and other non-stick and stain-resistant products. It is highly persistent in the environment and bioaccumulates efficiently through the foodchain and into biota. Therefore, PFOA contamination has been found in drinking water and house dust, and has been detected in significant portion of human blood samples. PFOA affects primarily the liver and can cause developmental and reproductive toxic effects at relatively low dose levels in experimental animals. It’s increased tumor incidence in rats, mainly in the liver. Epidemiological studies in PFOA-exposed workers do not indicate an increased cancer risk. Some have shown associations with elevated cholesterol and triglycerides, or with changes in thyroid hormones, but overall there is no consistent pattern of changes. In recent studies, PFOA exposure of pregnant women, measured by maternal and/or cord serum levels was associated with reduced birth weight. The European Food Safety Authority (EFSA) noted that these observations could be due to chance, or to factors other than PFOA. EPA has recently developed a drinking water health advisory, based on reproductive effects in laboratory animals.

PFOA exposure has been the subject of multiple class-action lawsuits, filed on behalf of residents who have been exposed through contaminated groundwater. More information about the regulatory and litigation issues can be found on SKAPP’s web site. According to a January 20th news item published in the InsideEPA.com Risk Policy Report (“PFOA Rulings May Stymie Plaintiffs’ Use of EPA Risk Methods in Tort Suits”), Federal judges in West Virginia and New Jersey declined class-action status to plaintiffs seeking medical monitoring from DuPont due to contamination from perfluorooctanoic acid (PFOA). These rulings were based in part because the plaintiffs used EPA-backed risk assessment methods to argue their cases.

According to the West Virginia court, plaintiffs seeking medical monitoring must show significant exposure, meaning exposure to higher levels or for a longer duration than the general public. Next, plaintiffs must show they experience a significantly increased risk of contracting a particular disease relative to that in the absence of exposure. The court agreed with DuPont that the plaintiffs as a class could not show an increased health risk, because each class member’s risk would vary based on variations in PFOA exposure and variations in each individual’s background risk in the absence of PFOA exposure (background risk may vary from person to person depending on individual characteristics and habits). Rejecting class action status creates an obstacle in the plaintiffs obtaining reimbursement from DuPont for the costs of medical monitoring. Just this month, the federal district court in New Jersey rejected a similar class action suit against DuPont.

An interesting development was the courts analyses of the role and limitations of regulatory risk assessment. In the opinion of the West Virginia judge, risk assessments were of limited utility in a toxic tort case especially for the issue of causation. Risk assessments have largely been developed for regulatory purposes, and serve a protective function in identifying levels below which there is no appreciable risk to the general population; they do not provide information about actual risk or causation. Risk assessments use appropriately prudent assumptions when there are limited data, and therefore intentionally present the upper range of possible risks. Other court decisions are cited for rejecting the use of regulatory standards as measures of causation because their role is to reduce exposure to harmful substances, and for determining that upper-bound risk estimates developed with EPA risk methods appropriately overstate risks for regulatory purposes (where caution is warranted), but are inappropriate for determining whether medical monitoring should be instituted.

The New Jersey court observed there is a difference between a “safe” level for public policy and regulatory purposes and the “significant exposure” that creates excessive risk triggering medical monitoring, and also concluded that a risk assessment methodology “does not work in the tort litigation context”, where a plaintiff must prove there is an actual increased risk of disease in order to receive medical monitoring.

Several things come to mind about the implications of these rulings, beyond setting the bar higher for plaintiffs exposed to toxic substances to be able to get relief through class-action suits. They reinforce the conventional wisdom that regulatory risk assessments are highly conservative and that they overstate the health risks associated with exposure to toxic substances:

While risk assessment information about a chemical can be somewhat useful in a toxic tort case, at least in terms of setting reasonable boundaries as to the likelihood of causation, the impetus for the development of risk assessment has been the regulatory process, which has different goals. Because of their use of appropriately prudent assumptions in areas of uncertainty and their use of default assumptions when there are limited data, risk assessments intentionally encompass the upper range of possible risks.

This isn’t a uniformly held view. There is a compelling argument made that the relationship between uncertainty and conservatism in risk assessment is complex, and that the conventional wisdom includes several unstated assumptions such as there is some underlying “true” risk that could be reflected by a “best estimate” of risk but which is being overstated by the regulatory risk assessment, and that decisions to manage that “true” risk can be made an unbiased manner without consideration of issues such as trust or equity.

In addition, it is possible that our current concepts of risk assessment, which grew out of the National Research Council’s (NRC) “Red Book”, and further articulated in the NRC’s “Blue Book” and the Presidential/Congressional Commission on Risk Assessment and Risk Management, have been superseded by more recent thinking about what biomarkers and toxicogenomics might be saying about the relationships between exposure and adverse effects, how cumulative risk concepts affect our notions of what’s a significant risk and what’s causation, and how risk assessors, regulators and the public (and judges and attorneys) should interact in understanding risks and decisions made to manage them. In particular, the variability in exposure that the courts used to reject the class action status might very well be the key to identifying the individuals who are at risk. However you can’t identify them without a monitoring program which evaluates variability. I think there is more work to be done here to get to a satisfactory remedy.

Greetings to President-Elect Obama's Transition Team

Hi President-elect Obama’s transition team and thanks for stopping by. You’re asking people for their ideas on energy and the environment, and here’s my contribution. My apologies in advance for not using the dinky comment box provided on your website, but this does allow me to develop ideas a little more fully. I’ll be brief.

Vapor intrusion is a growing problem with hazardous waste sites being cleaned up under Superfund and RCRA Corrective Action. Vapor intrusion occurs where there is contamination of soil or groundwater with volatile chemicals such as the solvent TCE, the dry-cleaning chemical PCE or petroleum hydrocarbon constituents such as benzene. If there are buildings located near the volatile contaminants in soil and groundwater, these can migrate into indoor air and can be inhaled by the occupants. Residents in communities affected by vapor intrusion are concerned about the health risks from inhaling these volatile chemicals. I speak about this issue as someone who has investigated vapor intrusion at hazardous waste sites across the U.S., and has participated in many national conferences on vapor intrusion sponsored by EPA, Air and Waste Management Association and other organizations.

One solution to vapor intrusion is to install engineering controls to prevent the volatile chemicals from entering a building. These are the same types of engineering controls that have been used for many years to prevent radon from entering buildings. These engineering controls work by preventing the leakage of air through the floors and walls of a building, a fact which spawned the idea of linking mitigation of vapor intrusion with building energy conservation. “Green building” techniques increase energy efficiency and improve indoor air quality in buildings by eliminating air leakage and by reducing the pressure differences between outdoors including the subsurface and indoors - the same strategy as used for mitigating vapor intrusion.

Linking green buildings concepts and vapor intrusion provides a significant opportunity to promote vapor mitigation and reduce health risks, while achieving co-lateral environmental benefits such as energy conservation with corresponding reductions in greenhouse gas emissions. An example of the growing importance of building optimization is shown in the principles of building design that are incorporated into Executive Order (EO) 13423, enacted in January 2007. This EO requires federal agencies to achieve reductions in greenhouse gas emissions and energy use. Some of these reductions will occur through the sustainable design and operation of buildings.

There are some barriers that need to be overcome to achieve this linkage of hazardous waste cleanup and energy conservation. Guidance and new regulations may be needed to change the mind-sets of regulatory agencies which don’t see these engineering controls as permanent measures for reducing vapor intrusion risks. A regulatory bias against vapor-resistant construction as a remedial measure for controlling vapor intrusion can delay final cleanup decisions and can represent a barrier to the development of brownfield sites. There may also be research needs to fully integrate building energy conservation methods with the control of vapor intrusion. Another important question to be answered is how to give responsible parties – those on the hook for cleaning up the Superfund or RCRA sites – “credit” for doing and paying for more work than what’s specifically required for cleanup.

Green jobs and new forms of collaboration and teamwork in hazardous waste site cleanup are some of the benefits from linking vapor intrusion and building energy conservation. I am working with my colleagues to flesh out these ideas, and give them wider visibility. I cordially invite you to be a part of that effort. Thank you.

Evil Corn

For me, reading political blogs is akin to smoking – it’s a filthy habit. These days, I read largely for amusement because the amount and quality of actual information I glean from them is generally pretty small. And it soaks up more of my time than is really good for me. While it doesn’t justify the time I expend, I do run across a nugget from time to time. For example, here’s a tidbit about GM (genetically modified) foods breathlessly posted by Christy Hardin Smith over at Firedoglake. She’s alarmed because there may be some recent and preliminary evidence that corn modified to produce Bacillus thuringensis (Bt) toxin may produce infertility in mice, and therefore we’re all going to become sterile. Per standard operating procedure with ideologues who slice the world into good guy/bad guy narratives (GMOs = Monsanto = BAD), the post was thin on details, but there was a trail of breadcrumbs pointing to some richer sources of information which looked interesting enough to break my blogging fast. As I peeled this onion, I found that this issue has more complexities which, if you want to do more than foam at the mouth about how evil Monsanto is, need to be explored and incorporated into the policy discussion. For now, I’m going to pass on commenting on her subsequent handwringing about linkages of Bt corn and infertility with reproductive health risks associated with endocrine disrupting chemicals. The liberal blognoscenti can get educated about cumulative risk assessment some other time.

Gourmet magazine online has more of the story on Bt corn here. The Center for Food Safety press release has a link to the study. The study itself is published by the Austrian Federal Ministry for Health, Family and Youth, which is responsible for regulation of genetically-modified organisms under European Union directives. There, that wasn’t so hard was it? I’m not going to demand that folks wade through the entire 105 page report, but they could at least struggle through the page and a half executive summary.

The researchers fed mice a diet of 33% genetically modified corn which produces Bt toxin along with control groups fed 33% non-genetically modified corn. Two different kinds of reproductive studies were performed, a multi-generation study where the mice were fed GM (or non-GM) corn and bred over four successive generations, and a “reproductive assessment by continuous breeding” where the same generation of mice were fed GM (or non-GM) corn but delivered four successive litters. These studies were designed to identify reproductive hazards, and don’t directly reflect the risks associated with the patterns or levels of consumption of GM corn by humans (this kind of work is combined with other research to address those questions).

The multi-generation study is probably inconclusive; the differences in numbers of offspring between the GM and non-GM groups were not considered to be statistically significant. The experimental design involved 24 breeding pairs of mice per study group. Would larger study groups produce more statistical power? The “reproductive assessment by continuous breeding” (RACB) study showed significantly reduced numbers of offspring in the mice fed GM corn. The investigators state that the multi-generation study design is less physiologically demanding on the animals compared with the RACB design – suggesting that the RACB study might have been more sensitive.

The Austrian investigators did some admittedly cool genomic testing, which reportedly identified some differences in metabolic pathways between the GM and non-GM mice. This kind of genomic testing is in its infancy, so there isn’t a lot of experience in how to use the data. But many feel there’s a lot of potential value in genomic techniques.

Monsanto questions these results, noting the overall higher offspring mortality in both the GM and control (i.e. non-GM) groups in the RACB study, and pointing to flaws and limitations in the presentation of the results. Its position is that when the results are correctly interpreted, they don’t indicate a reproductive effect. Monsanto also questions the data quality of the genomic testing as well as the interpretation of the results.

This is as it should be. Think what you will of Monsanto, but I found its comments a useful counterpoint in my understanding of the Austrian study. Monsanto might have a fair criticism in blasting the Austrian government by doing science by press release. When you do that, someone with a megaphone, who might not worry over the details, is bound to broadcast the wrong message. The question people should be concerned about is not “is GM corn in my food going to make me sterile”, but rather why we are examining long-term reproductive effects of genetically modified foods, consumed by hundreds of millions of people, years after they’ve been introduced into the foodchain.

However, solving that puzzle requires revisiting the history of the safety assessment of GMOs, and is just going to have to wait for another day (that blogging versus day job tension again).

Footnote: there’s a nice primer on genetically modified Bt corn over at the Science Creative Quarterly, published by the University of British Columbia.

Sweating the Small Stuff

As with many others, I’ve watch the value of my 401K account drop as markets tumble through greed, fraud and incompetent financial practices. I’m glad I’m eating my vegetables and taking my antioxidants and fish oil to give me a long working lifetime to rebuild my assets after the “meltdown” has subsided.

So the financial markets tank because the Masters of the Universe have been strip mining them, and Congress and the administration drop everything to wrestle with the resulting crisis (does anyone know if they’ve passed the 2009 federal budget yet?). The current financial upheaval is being used by climate-change-denier-fugitive-from-reality Rep. James Imhofe as an excuse to put global climate change mitigation on the blocks, an unbelievably stupid idea, since climate change mitigation represents the largest public works opportunity since the Bureau of Reclamation started building dams, potentially putting millions to work.

I’m sure that people across the country worrying about their retirement accounts aren’t interested in hearing about this, but in perspective, the financial crisis is the small stuff. The BBC has recently reported on a study recently published by the EU which estimates that the global economy is losing more money from the disappearance of forests than through the current banking crisis.

That study, titled The Cost of Policy Inaction: the case of not meeting the 2010 biodiversity target (COPI for short), part of the first phase of the EU’s The Economics of Ecosystems and Biodiversity (TEEB) program, is well-written and densely informative. Sound bites do not jump out of it, so it completely unsuited for American short attention spans, and I wonder if anyone on this side of the pond is going to bother to read even the 16 page executive summary. The 2010 biodiversity target refers to the EU’s Potsdam Initiative proposed by the German government during a meeting in March 2007 of the environmental ministers of the G8 countries and five major newly industrializing countries. The Potsdam Initiative recognizes the economic importance of biodiversity and “ecosystem services”. Ecosystem services include water purification, sequestration of greenhouse gases, natural products (pharmaceuticals), fisheries, timber, erosion control and nutrient cycling. These are public goods with no markets and no prices, so unlike toxic mortgages, there are no economic warnings that go up when ecosystem services are imploded.

A taste of what the COPI report provides is with the trends in fisheries. The executive summary of the COPI report contains this cheery plot of the unsustainability of global marine fisheries, projecting that they are all fully exploited, over-exploited or have crashed. In terms of the societal consequences of collapsing fisheries, the report states:

It is estimated that 1 billion people worldwide are dependent on fish as their sole or main source of animal protein, while fish provided more than 2.6 billion people with at least 20 percent of their average per capita animal protein intake. The expected decline of ocean fisheries will therefore have severe social consequences.

And speaking of where my next bottle of fish oil will be coming from from, the report didn’t even get into the cognitive decline from inadequate consumption of omega-3-fatty acids, which are essential for brain development in children. So, we’re not only starving succeeding generations but leaving them less equipped to deal with global ecological crises.

Since a lot of people can’t come to grips with this issue in terms of starvation and human suffering, the COPI report thoughtfully breaks this down monetarily. The study concluded that the world is expected to have lost land-based ecosystems services (such as forests) worth around 1% of the world Gross Domestic Product in 2010 or 545 billion Euros (733 billion dollars), due to biodiversity losses between 2000 and 2010. This is acknowledged to be an underestimate, and one objective of the second phase of TEEB is to account for what’s missing (oceans, coral reefs, watersheds, ecotourism, pollination services, invasive species (biodiversity as pest control), biochemicals and pharmaceuticals. There are also cumulative impacts not accounted for; one example is that much of the land-based losses are in carbon storage, which increases climate change impacts, and there may be costs associated with adapting to impacts from climate change (think about the disaster response and recovery from Hurricane Katrina). And, according to a new report from the WWF (formerly the World Wildlife Federation), climate change is accelerating faster than predicted in the most recently published IPCC report.

So, we have to mount the most revolutionary economic and social transformation of the human species ever seen in recorded history to respond to the twin challenges of climate change and biodiversity loss, with the time available to intervene running short. And, based on all of the indicators, we can’t even get it started.

I’m full of good news today.

Setting the Bar Low on Houston Air Quality

The Pump Handle passes along a news report that Bill White, the mayor of Houston is crossing swords with Lyondell’s refinery over benzene emissions. He wants the refinery to achieve further emissions reductions, and wants the Texas Commission on Environmental Quality to monitor more stringently emissions and fenceline concentrations in air. Benzene emissions from the refinery are below TCEQ permit limits, but the story in the Houston Chronicle says it’s not clear how those limits were developed.

I’m for reducing emissions to as low as reasonably achievable, because it’s a sign that you’re committed to the best industrial practices. However, there's another perspective here. When the Mayor's own task force on Houston air quality concluded:

Air pollution levels in the City of Houston are considered to be unacceptable by knowledgeable experts and the general public and are likely to cause air-pollution related health effects for Houston residents. Pollutant levels are driven by many sources including: tailpipe emissions from cars, trucks and buses; toxic pollutants emitted into the air by more than 400 chemical manufacturing facilities, including 2 of the 4 largest refineries in the U.S.; the petrochemical complex along the Houston Ship Channel and the Port of Houston; and many small operations spread geographically across Greater Houston, such as surface coating processes, dry cleaners, gas stations, printing processes, restaurants, charcoal barbecues, and gasoline-fueled lawn maintenance equipment,

what does he hope to accomplish by singling out Lyondell?

The leaders and citizens of Houston and the state of Texas made their choices long ago to become "business-friendly" which correspondingly meant a lack of commitment to environmental quality; they also chose to become highly reliant on motor vehicles (which by the way are probably the more widespread and significant sources of exposure to air toxics such as benzene). If Mr. White is really interested in improving air quality and public health in Houston, he really should be aiming his sights a little higher than one oil refinery. Lyondell could reduce its benzene emissions to zero and I would defy anyone to show any meaningful reduction in community exposure to benzene, without any action to control the mobile and area sources. I suppose focusing on Lyondell is a start, but at the same time, couldn’t he try to persuade Houstonians not to drive their cars so damn often?

EPA’s Draft Toxicological Review of PCE and (Once Again) What’s Wrong with Risk Assessment?

I wasn’t sure I was going to play in this sandbox again. I’m not really involved with volatile organic compound risk assessments anymore. I’ve expressed the opinion that what we need is not another toxicological assessment, but some action to replace the highest-exposure uses with some implementable alternatives. Outside of the workplace, perc isn’t terribly high on the list of environmental health hazards. But there is a framework in place for replacing it with lower-toxicity substitutes which could be template for other, more hazardous, compounds.

But instead, we have a draft toxicological assessment that is intended to provide toxicity values on EPA’s Integrated Risk Information System, which can then be used for risk assessments.

Just by eyeball, the estimated risks are similar to the last risk assessment conducted, done by Cal-EPA in the late 1990s. So, I’m not sure what’s been gained here – while it seems to be well-written, I’m wondering how this risk assessment is going to help us make faster or better decisions about managing PCE risks, given that it doesn’t say anything terribly different from what we knew a few years ago, and does not put much energy behind PCE risk-based decision making. In fairness, I should note that it’s not intended to be a policy document – its purpose is to make sure that good science and the right values are put up on IRIS.

At a high level, EPA’s assessment says that PCE is “likely to be carcinogenic” in humans by all routes of exposure and that the primary non-cancer toxic effects of PCE exposure in humans occur to the central nervous system, kidneys, liver and developing fetus. On the quantitative side, EPA judges the cancer potency of PCE to be slightly higher compared with its previous risk assessment, conducted in the late 1980s/early 1990s. Also, EPA judges PCE to pose slightly more of a non-cancer health risk, compared with previous assessments.

Once again, I’m wondering how we address what’s broken about risk assessment. I’m apparently not the only one:

However, risk assessment is at a crossroads. Despite advances in the field, risk assessment faces a number of significant challenges including lengthy delays in making complex decisions; lack of data leading to significant uncertainty in risk assessments; and many chemicals in the marketplace that have not been evaluated and emerging agents requiring assessment.

This is from the teaser from a forthcoming book from the National Academy of Sciences, Science and Decisions: Advancing Risk Assessment. This book promises to build off of the original framework for risk assessment, published in the book published in 1983 by the NAS, Risk Assessment in the Federal Government (also known as the Red Book). The Red Book established a framework for much of risk assessment as it is practiced today Science and Decisions, “embeds these concepts within a broader framework for risk-based decision-making.” Maybe it will contribute to “fixing” risk assessment. We’ll see. I’ve ordered a copy and will discuss it in a future post.

The Geopolitical Angle of Public Health

Conflict is never good for public health, though for some commentators that’s such a limp-wristed reason not to fight. The bellicose bloggers such as Ralph Peters and Victor David Hanson reminds one of the bit of apocrypha said of George S. Patton by some, “our blood, his guts” (rendered sardonically by an actor playing a dogfoot in the movie “Patton”). It also brings to mind the saying “amateurs discuss tactics, professionals discuss logistics” (yep, we’re going to be able to mount any sort of meaningful response to Russia’s incursion in Georgia while in the midst of two other conflicts). However, when your mind is in the clouds maneuvering squadrons, fleets and brigades around, there just isn’t time to pay attention to the fallout, such as hunger, dislocation, and epidemics.

Or maybe public health has more of a role in generating conflict than these bush-league Clausewitzs will acknowledge. There are some interesting perspectives on this in a recent article in the Asia Times – actually, there are several interesting perspectives, including the one that all Russian politicians are clever because the stupid ones are dead, whereas we currently have the stupid ones running everything right now. But what drew my attention was Russia’s demographic dilemma and how that might be a cause for its aggressive behavior (though the US and EU trying to extend NATO up to Russia’s doorstep might also have a role. . .).

The article paints a bleak picture demographically for the Russians running things in the country – falling birth rates among ethnically Caucasian Russians, abortion used as a means of birth control, declining life expectancy – and probably a whole host of other issues (I need to take a stroll over to the WHO web site sometime and review the statistics). The geopolitical angle around Russia trying to reclaim its old republics is:

Demographics stand at the center of Putin's calculation, and Russians are the principal interest that the Russian Federation has in its so-called near abroad. The desire of a few hundred thousand Abkhazians and South Ossetians to remain in the Russian Federation rather than Georgia may seem trivial, but Moscow is setting a precedent that will apply to tens of millions of prospective citizens of the Federation - most controversially in Ukraine.

We’ve only explored the fertility angle, and haven’t drilled into other issues of morbidity (caring for the millions made ill from poor diet, alcoholism and smoking), demographic troughs (fewer younger people to care for millions of elderly) or, most speculatively, fertility and neurobehavioral disorders from exposures to persistent organic pollutants and mercury. It may seem presumptuous to elevate pollutant exposures as a significant demographic contributor to geopolitical conflict. However, it’s probably prudent not to neglect them in strategic analysis, given the widespread nature of human exposure to these substances, coupled with the kinds of health effects they might be associated with, along with the uncertainty regarding occurrence and magnitude of those effects.

It’s interesting that we obsess on the resurgent Russia, an energy and geopolitical player on the world stage, and don’t give any consideration that behind the façade is a country full of sick and aging people. It’s both a warning to us, as well as a clue for how to manage Russia’s aggressive tendencies. No word yet on how we manage our aggressive tendencies.

Precaution and Triclosan

The other day I was pointed to an article by Cass Sunstein in the Boston Globe online, about the precautionary principle. I agree with Dr. Sunstein that fundamentally the precautionary principle is incoherent as a risk management tool, at least in the way a lot of the “deep green” people view it. All policy choices entail risks of some form; these may be disparate risks that fall differentially across the population, but we risk making irrational decisions if we don’t try to wrestle with them. Some of his examples are pretty dim, but then again he’s writing for the general audience, who is pretty dim when it comes to making decisions where uncertainty is involved.

In most or nearly all cases where risks are being assessed, you’ll be making a decision based on incomplete information. It may not be prudent to allot the time or resources to do the studies to more fully assess a risk before deciding to act on it. Indeed, the call for more study has become a strategy used by some corporations for deferring action on controlling health risks associated with their products, or with chemical substances that their workers are exposed to. It’s effective too, because, like the general audience, nearly all policy makers are genuinely bad dealing with environmental decisions under uncertainty.

There’s a “strong” version of the precautionary principle, which in effect is to take action to stop something that poses a significant risk until you prove it’s safe. That’s a recipe for either precipitous action or inaction, with Dr. Sunstein’s favorite example being invading Iraq. The more reasonable version of the principle suggests that a lack of decisive evidence of harm should not be grounds for not taking action. For example, the 1992 Rio Declaration, setting out principles for sustainable development, states, "Where there are threats of serious or irreversible damage, lack of full scientific certainty shall not be used as a reason for postponing cost-effective measures to prevent environmental degradation" (see Principle 15).

Of course, matters become more difficult to resolve in practice. A good example is antibacterial soaps containing triclosan. Soaps containing triclosan were no more effective than plain soap at preventing infectious illness symptoms and reducing bacterial levels on the hands. Also, several laboratory studies demonstrated evidence of triclosan-adapted cross-resistance to antibiotics among different species of bacteria. The conclusion of a recent review was:

The lack of an additional health benefit associated with the use of triclosan-containing consumer soaps over regular soap, coupled with laboratory data demonstrating a potential risk of selecting for drug resistance, warrants further evaluation by governmental regulators regarding antibacterial product claims and advertising. Further studies of this issue are encouraged.

Triclosan is used extensively in consumer products, including personal care products, textiles, and plastic kitchenware. The triclosan molecule has some structural similarities to phenols, diphenylethers and polychlorinated biphenyls (PCBs). It is widespread in low levels in waterways throughout the U.S., and has the potential for bioaccumulation in the environment. Biological monitoring performed by the CDC in 2003 and 2004 has detected triclosan in 75 percent of the urine samples collected from a representative sample of the U.S. population. In other words, traces of triclosan are detectable in a large number of people. Finally, triclosan was recently screened using mammalian cell lines for endocrine disrupting potential, and yes, there’s a possibility it’s an endocrine disruptor (potentially interfering with cell signaling that occurs in brain, heart and other cells, according to the UC Davis researchers).

Antibacterial soaps and consumer products have been identified as risk factors for antibiotic resistance. Infections from Methicillin-resistant Staphylococcus Aureus (MRSA) are becoming a growing concern for hospitals and healthcare professionals. Recommendations for managing MRSA in the community aren’t calling yet for getting rid of soaps and products containing triclosan. Noone is calling triclosan a threat to human reproduction yet (for example, CERHR isn’t investigating it).

However, it does raise the question of when action is warranted to reduce exposure to triclosan. There’s limited evidence that it isn’t terribly effective as an antibacterial agent in consumer products, and may contribute to antibiotic resistance. It’s widespread in the environment, bioaccumulative, detectable in humans, and now has emerging evidence of subtle adverse effects that might affect future generations. Absolutely nothing conclusive about any of it, but with the currently regulatory framework and political environment, it could involve decades of study and deliberation before a decision is made that widespread use of triclosan poses a risk or not. Then, if the determination is yes, it poses a risk, several more years would be required before it’s out of the product distribution chain.

This seems like a perfect application for the precautionary principle. However, until the precautionary principle develops some intellectual rigor, and possibly a quantitative framework, it’s going to remain a nice idea without a lot of decision-making punch.

We Knew That

I just picked up an abstract from the open access journal Environmental Health which presents a review of cancer epidemiology studies at hazardous waste sites. Epidemiology is the science and art that attempts to identify the relationships between disease and environmental factors. Some of the most painstaking investigative work in science occurs in epidemiological investigations. A classic example is the investigation of occurrence of cholera in London, conducted by John Snow As a part of this investigation, Snow mapped the locations where cholera cases occurred along with the locations of the local water pumps, thus creating the story of “the pump handle”.

The conclusion from this study was that epidemiological investigations generally did not provide a lot of information about whether communities near hazardous waste sites experienced an increased cancer risk or not. Limitations in the study design and limited information regarding levels of exposure were cited as support for this conclusion.

This study was funded by the City of New York. Why the City of New York is interested in drawing attention to the limitations of hazardous waste epidemiology isn’t made clear. However, it isn’t really news that hazardous waste epidemiology is grossly imperfect. We knew that already back as 1991. What is surprising is how little appears to have changed in the intervening years.

Most of the studies reviewed in this recent paper were identified as ecological studies, which examine rates of diseases between different groups (i.e. a community using contaminated groundwater compared with a community using an uncontaminated supply). Detailed information on the health status of individuals or detailed exposure information generally is not part of an ecological study. An ecological study is most useful for generating hypotheses and scoping more detailed epidemiological studies. Limited modeling or sampling data were incorporated into these studies, particularly measurements at the locations where individuals were most likely to come into contact with hazardous waste contaminants.

There’s a whole litany of things that could be done better here. We’ve known about these for a long time, but haven’t bestirred ourselves to deal with them.

The exposure data for assessing hazardous waste site contaminants is very limited, but we can’t all be tobacco epidemiologists who get to work with human populations who dose themselves like they were laboratory animals. There hasn’t been enough emphasis on community-based participatory methods for increasing community cooperation with exposure studies, as well as not enough emphasis on risk communication to help explain that simply looking for exposure doesn’t necessarily mean there’s a significant risk. From personal experience, I am aware that residents get understandably edgy when you want to come in to collect air samples from inside their homes or soil samples from their yards. They naturally run to the conclusion that there must be a problem (if there wasn’t, we wouldn't be looking, right?). However, because risk assessors are unable to discuss exposure and health risk in simple English, decision makers really don’t have a clue about what’s really going on, and everyone is afraid to speak up without a bunch of hedging and qualifying when the lawyers are in earshot, the people who have the biggest need to understand what’s going on – the neighbors to a hazardous waste site – routinely don’t get a straight story.

There’s the two-part problem of the lack of conclusiveness of epidemiology, coupled with the extremely sensitive perceptions of risks, both of which contribute to the sense of anxiety and uncertainty in the neighbors of hazardous waste sites. Both parts, the relative risk of 2.0 as evidence of causation, and the excess lifetime cancer risk of 1 in 1,000,000 as a threshold of acceptable risk, do not appear to be grounded in any sort of public health reality. It’s an obscure point, which is the topic for another post (because this one’s getting too long. . .).

We don’t seem to have learned anything from epidemiology to better inform hazardous waste decision making. Therefore, we fall back on making cleanup decisions using the crudest of risk assessment methods, which either don’t address real and significant health risks, or are a wasteful expenditure of resources in relation to the amount of risk reduction that occurs.

The Sad State of Environmental Health Policy Today, Redux

My first essay on this topic is posted here.

Keeping to my New Year’s resolution to blog more has been difficult. I moved our household across the country in preparation for a new job, and for the past several weeks, I was busy studying for my examination for recertification as an industrial hygienist (update: I took the test last month – and just received notice that I passed, so I’m still a CIH). I’ve also felt pretty played out on the blogging front, so I took a vacation from it.

Not that there haven’t been things to blog about. Revere weighed in on EPA’s “streamlining” of its Integrated Risk Information System (IRIS), a data warehouse of focused toxicity profiles and values for use in quantitative risk assessment. That post is spot-on in terms of how the Bush Administration is tinkering with transparency and accountability with yet another environmental health system. Where I differ with Revere is in the overall value of IRIS, which was characterized as:

Considered authoritative by many states and countries, its judgments have become the basis for official standards. It's been around since the start of Reagan's second term (1985) so there is no claim it is some kind of fringe environmentalist fantasy. It's not the Last Word but it's a loud voice and taken seriously by anyone tasked with protecting the public from toxic hazards.

Having been an IRIS power-user for many years, I would argue that IRIS wasn’t that even in its heyday. It’s true that the usability has been further reduced from the slowdown of profiles being posted on it. However, IRIS profiles for several of the highest profile chemicals have lagged for years, sometimes predating the first Bush Administration. Hundreds of other profiles aren’t consistent with the most current data or risk assessment methods (which is actually less of a problem than you’d imagine – I would argue that many of these aren’t significant environmental regulatory drivers anyway). We don’t just have a problem with politically meddling in regulatory science, but a problem with how toxicity assessments get done. Actually, we have a problem in general with how risk assessments are getting done these days (see here, here and here), but I’d rather not get into that now, because I’ll just start to rant incomprehensibly. . . .

IRIS isn’t the real travesty in health standards. That honor is reserved for OSHA’s Permissible Exposure Limits (PELs). Twenty years ago, OSHA published a final airborne contaminants rule amending the PELs, making values more protective for 212 chemicals, and promulgating values for 164 more, the first widespread update of the PELs since the OSH Act was enacted in 1970. At the time, there was a lot of hand-wringing about this streamlined approach for developing standards for nearly 400 chemicals, particularly in relying on TLVs. Ziem and Castleman have been prominent critics of TLVs – a summary of their arguments along with a historical perspective on the airborne contaminants rulemaking is presented in Chapter 7 of Illness and the Environment: A Reader in Contested Medicine. That rule was overturned in court in 1992 [AFL-CIO v. OSHA, 965 F.2d. 962], with the court concluding that OSHA needed to do an independent risk analysis on nearly 400 chemicals. So, currently, the PELs in force are based on the TLVs from the late 1960s. The exceptions are PELs that have been promulgated more recently as part of chemical-specific standards, such as benzene, vinyl chloride or hexavalent chromium. OSHA hasn’t attempted to promulgate new standards, and Congress apparently hasn’t seen fit to act in this matter either. This is just another example of how occupational and environmental health is important enough for the public to wring their hands over, but not important enough to deal with effectively.

An aside: what is interesting to me is how their reputation has been somewhat rehabilitated, since anti-regulatory critics have aimed their sights at TLVs. Celeste Monforton summarizes that controversy on Defendingscience.org.

You could run down the list of standards, advisory values, criteria and find similar situations. EPA’s Ambient Water Quality Criteria were created in the 1970s and early 1980s, and have not been updated in the intervening years, which ties in with the fact that most of the IRIS profiles haven’t been updated either. Same story for the drinking water standards, or Maximum Contaminant Levels (MCLs), most of which were last updated in the mid and late 1980s. National Ambient Air Quality Standards are updated at a glacial pace.

I’ve wondered why environmental regulations don’t keep pace with the emerging science. My current speculations go like this: the methods for toxicity and risk assessment have become more complex. Thus, the analyses take more time, and perhaps provide more opportunities for criticism by stakeholders such as industry groups and federal agencies such as DOD. Rulemaking processes are adversarial, which provides further scope for criticism and manufactured uncertainty. Public desires for no uncertainty regarding understanding of health effects, along with assurances of zero risks push us to the very margins of what laboratory studies can provide in terms of prediction of adverse effects (bisphenol-A is a good example of what science can and cannot say about adverse effects).

It seems that the regulated industries have articulated a strategy (including slowing regulatory processes with doubt and backing the winning horse politically) for how to address environmental and health hazards from chemical contaminants, which these days appears to routinely outmaneuver environmentalist and other progressive stakeholders. With a political sea-change in the offing, it will be interesting to see environmentalists will make some progress in altering how chemical hazards are managed.

The Sad State of Environmental Health Policy Today

The other day, Revere was discussing John Edwards’s presidential platform on cancer, and expressing disappointment that Senator Edwards gives virtually no attention to prevention, including regulatory approaches for reducing carcinogenic exposures and incentives for promoting “green chemistry” in manufacturing. I checked over at Hillary Clinton’s web site, which has a bit more meat on this topic: smoking prevention in young people, getting junk food out of schools, and improving biomonitoring of exposure to toxic substances. However, it’s only a slight improvement over what John Edwards would provide for us. To the credit of both of them, they appeared at Lance Armstrong’s cancer forum earlier this week (most of the Republican candidates bailed on it).

It seems so hard for our politicians to inject the environmental health focus into the debate over health care. Perhaps it’s too difficult for them. Too much of our economic system would have to change. For example, in a paper published last month in Environmental Health Perspectives, the cancer risks from organic hazardous air pollutants were ranked for a non-occupational and non-smoking population. The chemicals providing the largest contribution to total estimated cancer risks in the U.S. were benzene, butadiene, formaldehyde, dioxins and chloroform.
Mobile sources (cars and trucks) are a large part of the emissions of benzene, butadiene and formaldehyde into the air. So, by inference, a key strategy for reducing exposure to these substances could be to reduce the amount that we drive, or ship stuff around by truck. The alterations to our daily lives could range from minor, such carpooling, greater proportion of working from home, or buying locally, to fairly life-changing stuff, including redesigning cities for walking and urban biking, substantially increasing the urban mass transit infrastructure, changing patterns of employment, old industries collapsing while new ones flourish. . . more examples are provided here. There would be collateral benefits, too: redesigning our built environment to be more friendly to pedestrians and bicyclists could create a health benefit, and possibly cut into health care costs, by increasing the amount of exercise people get (NIEHS had a conference on this topic in 2004); in addition, reducing vehicle-miles traveled also reduces our consumption of oil, which promotes energy independence and begin reducing greenhouse gas emissions, both of which pose a risk to national security. Oh, and all of the upgrading of our infrastructure that would be needed to accommodate fewer cars and trucks in our lives would create jobs. . . . Stop me if all of this is making too much sense.

Chloroform occurs in drinking water as a disinfection byproduct (most chloroform exposure occurs indoors when we use that water – either from drinking, or inhaling chloroform that volatilizes from hot water during showering or using a washer or dishwasher). While the disinfection of drinking water using chemicals such as chlorine has been a major public health success story by reducing the risk of disease, elevated levels of disinfection byproducts may be associated with an increased risk of bladder, rectal, and/or colon cancers and adverse pregnancy outcomes. Many water utilities use chlorine gas for disinfecting drinking water, and chlorine is transported around the country in rail cars. Derailments have created hazards and caused fatalities to communities in the past (I’ve blogged about one such story in Graniteville, SC in 2005; as discussed here, further work is needed to increase the safety of rail cars transporting hazardous materials). However, alternatives are available for disinfection of drinking water that can reduce the formation of disinfection byproducts and at the same time reduce accidental releases from derailments by limiting the amount of chlorine transported around the country. There would need to be an investment made to fund the retrofitting of water treatment plants – but again, you could look at this as an opportunity for job creation.

The story is bit different for dioxins. People are exposed to dioxins principally through the food supply, particularly by eating animal fat, dairy products and fish. In 2003, the Institute of Medicine published a report discussing strategies for reducing exposure to dioxins in foods. Overall, about 34 percent of the calories in American adults’ daily diet come from fat, and one-quarter to one-third of that is from saturated fat, which is largely animal fat. Recommendations for reducing dioxin exposure in the diet (which, by the way, would also reduce exposure to other lipophilic persistent organic pollutants) include changing agricultural production methods to interrupt the cycle of dioxins through forage, animal feed, and food-producing animals, particularly with regard to the use of animal fats as livestock feed. In addition, they recommend educating people about reducing the amount of fat consumed in their diets. In general, making people more aware of the consequences and benefits associated with what they eat can provide health benefits beyond reducing exposure to dioxins and persistent organic pollutants.

There are pollutants not covered in the EHP article, because they aren’t hazardous air pollutants, but that still are examples of how attention to environmental health can have collateral economic benefits. For example, nearly 2 billion pounds per year of bisphenol-A are used in the production of polycarbonate plastics. Polycarbonates are used to manufacture all types of plastic components, including food and drink containers. There potentially are problems with using polycarbonates in food and drink containers – bisphenol-A can leach from them and be ingested. This makes bisphenol-A a textbook example of an environmental toxicology and health policy problem. It's a commercially important chemical substance. Nearly all of us are constantly exposed to low levels of it. The mechanisms for potentially adverse health effects are subtle and occur at low levels of exposure. The most vulnerable populations for these effects are young children, both during pre-natal development and in infancy. The kinds of biological effects observed in laboratory animals with low levels of exposure include stimulating the growth of prostate (in males) and mammary tissues (in females), potentially increasing susceptibility to carcinogenicity later in life; alterations in hormonol with effects such as early onset of sexual maturation; and neurobehavioral effects. Recently, one study provided indications that BPA might promote insulin resistance, a risk factor for diabetes. These effects can be observed at levels around 10-fold greater than levels of exposure in humans, which is not a comfortable margin of safety. As yet, adverse effects have not been observed in humans, though there hasn't been a concerted effort made to examine human populations.

Bisphenol-A is not the only component in plastics manufacturing with health concerns. Health effects potentially associated with phthalates, used as plasticizers, and perfluorooctanoic acid (PFOA), the precursor used to make Teflon, are also under scrutiny. As with bisphenol-A, these substances are in widely used products, and we all carry around a small body burden of them. As can be imagined, there is a strenuous scientific debate about the presence and significance of adverse health effects from exposure to bisphenol-A, phthalates and PFOA, a debate which may never be satisfactorily resolved. However, there is an opportunity to promote the research, development and manufacturing of lower-toxicity materials for use in consumer products, which could help to reduce the uncertainty regarding health risks from plastics. There are many initiatives promoting “green chemistry” (the Lowell Center for Sustainable Production and the Clean Production Action project are resources for learning more about this topic). However, while the chemical manufacturing industry acknowledges the importance of green chemistry, redirecting it onto a more sustainable path will happen faster if political pressure is applied.

Which brings us around to what our presidential candidates have said about cancer prevention, and more importantly, what they haven’t said. Dealing with disease burdens such as cancer is more than just fixing health insurance and giving more money to NIH. It is taking a more holistic view of how physical and socioeconomic factors can affect human health. Environmental health is very much a democratic issue. The Democratic candidates for president should be able to say more about it than they currently are doing.

Public Health is a Treasonable Liberal Plot

I was wondering what it would take to lure me back from self-imposed exile to the blog playground. It wasn’t the raging warbloggers reinventing themselves as epidemiologists to issue indignant howls over the Johns Hopkins study of war-related mortality in Iraq (I don’t feel like playing that game right now, but you can look elsewhere for the fun – here, here, here, here and here). What did attract my attention though was the claim that:

The American public health community has a decidedly left leaning cast to it. It is more politically homogenous than any other medical specialty. How homogenous are they? Well, you won't find statements like this on the website of any other medical speciality. One is obliged to assume that the researchers started with a bias.

Well, you have to consider the source. It did come from MedPundit, a physician.

With authoritative statements from any specialist such as a physician, lawyer, academic, engineer, etc., you have to judge carefully whether or not they know anything about the topic. For example, it’s been a favorite tactic of creationist or intelligent design advocates to have someone, with a PhD in something scientific or technical-sounding such as chemical engineering, criticize the teaching of evolutionary biology in schools. The fact that Francisco Ayala or Ernst Mayr might not agree with this PhD scarcely matters. Someone with a credential criticized evolutionary theory, and that’s enough to for some people to discredit it.

I think the same issue arises when I see a physician rendering an opinion about a public health topic, say epidemiological studies of mortality from violence in Iraq. In judging the basis for their opinion, the first question that comes to mind is what is their experience in public health work? One of my first jobs 25 years ago was working in the state of California’s pesticide illness surveillance program, then under the California Department of Food and Agriculture (later moved to Cal-EPA). We would receive pesticide illness reports from physicians, and attempt to categorize them in terms of types of effects, pesticide associated with the effect, and exposure/effect relationship with additional investigation information provided by county agricultural commissioners. Through this experience, I received a good dose of what physicians did and didn’t know about public health surveillance, after observing inanities such as blood tests for chlolinesterase inhibition being administered to patients who had been exposed to paraquat, heat rashes being diagnosed as sulfur burns, cholinesterase test results from workers without any pre-exposure baselines, patients complaining of non-specific nausea, vomiting or dizziness being diagnosed as organosphosphate exposure, and on and on. We saw that some physicians in the state got pretty savvy with diagnosing and treating pesticide exposures. They had to – they were seeing a couple of farmworkers or pesticide applicators each week with exposure. But, they seemed to be the exception rather than the rule. We observed that more veterinarians appeared to be better at diagnosing pesticide exposures than physicians (we also used to compile poison control center statistics – the PCCs also received animal poisoning calls from vets).

I found out some interesting things by taking this allegation that the public health community “leaned left” and analyzing it. The Institute of Medicine (IOM) describes public health as what we do collectively to assure the conditions for people to be healthy. This formulation of public health includes societal activities beyond those performed by government. The constitution of the World Health Organization defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (yeah, I know, the UN is another leftish plot).

A distinction has been made between clinical practice and public health practice as methods for protecting and improving health:

Clinical practice is commonly thought to include “interventions that are designed solely to enhance the well-being of an individual patient or client and that have reasonable expectation of success.” The analogy to public health practice is that the “patient” in public health is the community. Under this approach, those activities performed to improve the health of the community are deemed public health practice. Though a helpful comparison, the analogy falls short of distinguishing public health practice and research where both activities may be motivated by the need to improve the population's health and may involve the practice of medicine or allied health professions under the standards of professional practice.

Taken at face value, MedPundit’s comments could imply that being a physician doesn’t automatically confer a sense of concern about the health of a community. However, some have argued that being an epidemiologist should:

Responsible professionals reliably perform the tasks they set for themselves as well as the tasks society expects them to undertake. The defining axiom for our approach is that the health of the public is a social good we commit ourselves to pursue, thus assuming an obligation to contribute to its achievement. Epidemiologists cannot claim to be committed to public health as a social good and not accept the responsibility of ensuring that the knowledge gained in their roles as scientists is used to achieve that good.

The ethics guidelines published by the American College of Epidemiology also mentions the obligation of epidemiologists to show how their studies provide public health benefits to the community. It’s a shame that similar guidelines haven’t been developed for politicians. In an article titled “Pursuing the Impossible”, published last year in the Harvard International Review, Dr. Ronald Waldman of Columbia University said:

Preventing the unnecessary loss of civilian life is the job of politicians, who have failed all too often. The world has stood by and watched as one genocide after another has unfolded. Although there is always great sympathy for the survivors, and although humanitarian assistance is frequently, but not always, forthcoming, the effect is, at best, that of applying a bandage to a gaping wound. The most important lesson to learn for the future—one that has already been learned but forgotten many times in the past—is that war and public health are fundamentally incompatible pursuits.

War and public health being fundamentally incompatible pursuits is a point that is obviously lost on the warbloggers, though it’s a bit surprising that some physicians apparently don’t understand it either. Concern about preserving and improving public health isn’t a left-leaning or right-leaning virtue, it’s a societal virtue. Epidemiologists aren’t performing their studies to further a leftist political agenda, they’re just doing their jobs. Alleging that public health professionals are harboring a liberal agenda is no more correct than the corollary that conservatives are the party of death and disease. Right?