Toxics now and forever Cathey Eisner Falvo MD

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

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

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

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

t P i rc o s g ra a n m d m i. P n r g o , g r N a a m tm i o n n g a , l N C a e t n i to e n ra l f o C re n It n e jr u rf y o r P r. I e n v j e u n r ty i o P n r e a v n e d n t C i o n t ra o n ld , C C o e n n t 10 Leading Causes of Death, United States 2007, All Races, Both Sexes bases on CDC data 1 -4 5 -9 10 -14 15 -19 20 -24 Unintentional Injury 1, 588 Unintentional Injury 965 Unintentional Injury 1, 229 Unintentional Injury 6, 493 Unintentional Injury 9, 404 Congenital Anomalies 546 Malignant Neoplasms 480 Malignant Neoplasms 479 Homicide 2, 224 Homicide 3, 327 Homicide 398 Congenital Anomalies 196 Homicide 213 Suicide 1, 481 Suicide 2, 659 Malignant Neoplasms 364 Homicide 133 Suicide 180 Malignant Neoplasms 673 Malignant Neoplasms 980 Heart Disease 173 Heart Disease 110 Congenital Anomalies 178 Heart Disease 346 Heart Disease 738 Influenza & Pneumonia 109 Chronic Low. Respiratory Disease 54 Heart Disease 131 Congenital Anomalies 191 Congenital Anomalies 211 Septicemia 78 Influenza & Pneumonia 48 Chronic Low. Respiratory Disease 64 Cerebrovascular 71 HIV 127

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

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

Toxic body burden • Flame Retardants: PBDEs • • • • Chemical Specimin Di. BDE-15 serum pg/g Tri. BDE-28 serum pg/g Tri. BDE-37 serum pg/g Tetra. BDE-47 serum pg/g Tetra. BDE-51 serum pg/g Tetra. BDE-79 serum pg/g Penta. BDE-99 serum pg/g Hexa. BDE-138 serum pg/g Hexa. BDE-153 serum pg/g Hepta. BDE-190 serum pg/g Octa. BDE-203 serum pg/g Nona. BDE-207 serum pg/g Deca. BDE-209 serum pg/g CF 158 1170 u 8680 u 28. 1 1790 55. 4 3110 u 165 684 u Study Max 486 5560 55. 109000 89. 4 245 24200 369 20900 151 295 1040 9040 • Bisphenol A BPA Urine ng/m. L 7. 11 • • Sanitizing Agent: Triclosan Urine ng/m. L • • • Phthalate Metabolites Mono-ethyl Phthalate (DEP) m-Et. P urine ng/m mono-2 -ethylhexyl phthalate (DEHP) m-EHP urine ng/m. L • • • Heavy Metals Lead Pb serum µg/L Mercury Hg serum µg/L 60. 3 200 2. 15 U 2. 27 Study Min 90. 5 91. 1 u 738 u u 595 u 98 u 67. 5 427 u CDC 50 th % 95 th % 1100 7900 19200 157000 <LOD 42200 4800 65700 0. 449 2. 7 15. 9 214 U 9. 2 459 200 U 181 2720 101 2. 06 31 2. 27 U U 4. 1 16 0. 7 39. 5 52 4. 6

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

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

POPs IN THE ENVIRONMENT AIR SOURCES Industry WATER Waste Traffic Agriculture LAND DEPOSITIO N Long-range transport • Airwater • Rain • Snow • Particle s. WATER & SEDIMENT DEPOSITION FOOD CHAIN Big fish Marine mammals

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

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

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

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

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

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

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

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

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

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

Thank you Questions ?

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

References and sites of use • • http: //ehp 03. niehs. nih. gov/home. action http: //www. cdc. gov/asthma/healthcare. htm http: //www. cdc. gov/exposurereport/ http: //www. cdc. gov/Environmental/l