Health Professionals on the Front Lines – Essay

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By Stephenie Hendricks

This module is part of an Environmental Humanities curriculum. Its research uses a Scholarly Personal Narrative (SPN) methodology, meaning stories are used as data, including the researcher’s own story. With SPN, research is subjective, and stories are anchored to larger themes and other scholarly research. The stories here are about some of those who have discovered and held emerging science and knowledge about environmental health.

These are my perceptions, with acknowledgement that former colleagues may recollect something that might be quite different. I encourage any former colleagues to contact me if you feel that what I am remembering differs from your memory and could in any way cause harm to you or your work.

Meet a Few Health Professionals on the Front Lines

Ughhh, Such a Downer!

        When faced with the fact that manmade invisible manmade toxic exposures might be contributing to rising rates of illnesses among the global population, some people shut down, put their fingers in their ears, scrunch their eyes closed, and say “NANANANANA! I don’t want to hear about it!” Others just flat out deny the science. And still others say, “Well, the world is going to end anyway, I don’t want to change my lifestyle; I want freedom!” Still others haven’t a clue about environmental health. Why? Part of the reason is sheer ignorance. Many people buy and sell things without thinking about the unintended consequences of hazards from harmful elements such as BPA, PFAS chemicals, lead, and other exposures, that are not required to be labeled or have not been tested for impacts on human health and the environment (Muir 9120). Others become overwhelmed by the enormity of the problems and just shut down.   

And then there are other people: environmental health defenders. You are about to hear about the work they engage in, which is not for the faint of heart. Here, we focus on stories from a few physicians, nurses, and health researchers I have had the honour to work with over the years, or whose work I’ve come to know. As you will discover in this essay and podcast, health professionals working on environmental health and environmental justice face enormous challenges. They are the ones witnessing and identifying associations between toxic exposures and suffering, and they are trying to educate others about these issues. They are “first responders” to this huge conundrum, especially in communities close to polluting areas that experience the most illnesses. However, you do not have to live near a chemical plant or landfill to have your health or the health of your family members impacted, because some chemical culprits lurk in consumer products while other persistent chemicals can travel long distances on wind, water, and dust, leaving behind contaminants with the “Grasshopper Effect” that is described in the podcast for this module. In short, we all are vulnerable to health impacts from manmade toxic chemical exposures; some of us more than others. In this essay, I share personal experiences as well as scholarly and scientific research as a companion to the podcast for this module.

The Impact of Toxic Exposures

1997

            “Mrs. Hendricks, Sarah has Hashimoto’s Disease.” I turn my focus from our pediatrician to my eight-year-old daughter, whose eyes are round with concern.

            I ask, “What does that mean?” while maintaining eye contact with Sarah. She is so sensitive and aware. I don’t want her to be afraid.

            “It means that her thyroid gland is impaired, and she will need to start taking medication for it right now, and probably for the rest of her life.”

            I move to the examining table and put my arms around her as she leans in, looking up at me.

            “It explains her fatigue and her recent growth spurt. That often happens with this condition – a sort of dysregulation of growth hormones.” The doctor scribbles out a prescription. “Overall, it’s not the end of the world. She’ll be fine.” He smiles reassuringly at her, and she relaxes a little.

            Privately, I’d been worried that Sarah’s fatigue and not feeling well was something worse – possibly leukemia. I’ve produced TV talk shows with families suffering with this disease that often strikes children. An occupational hazard from producing TV talk shows is being hyper suspicious of any symptoms that my family or I have that echo those discussed on a show that I produce. I allow relief and gratitude to shove my anxiety aside as we leave the doctor’s office. Still, something nags at me. What caused this? Was this something I inadvertently did to my daughter?

            Thyroid disease joins rising rates of asthma, obesity, diabetes, neurological problems like autism, learning disabilities, Parkinson’s Disease, and still yet more health impacts linked to ubiquitous manmade chemical exposures (DiRenzo et.al 219, Lavezzi 5764). Rates of cancers in children and young adults are also increasing. The Leukemia and Lymphoma Society reports that “Leukemia is the second leading cause of cancer deaths (after cancers of the brain and other nervous tissue) among children and adolescents younger than 20 years (“Childhood,” Siegel 1, Ugai 656), and often thought to be linked to environmental exposures (Carlos-Wallace, et al. 1, Hernandez and Menendez 10). The U.S. Environmental Protection Agency (EPA) and National Institute for Environmental Health Sciences (NIEHS) report that leukemia in U.S. children has gone up 35% in the last 40 years (“Children’s Environmental”). Statistics Canada reports that new cancer cases per year among all ages has gone from 117,975 in 1991 to 211,435 in 2017, the most recent year reported (“Number”).  Why are these rates of illness rising? Some say that cancer diagnosis rates are improving, resulting in more diagnosis (Drake ).  Another potential explanation is the fact that as the illness rates rise, so have the number of more than 300,000 new unregulated or under manmade toxic chemicals linked to many of these illnesses introduced into the marketplace in the last 60 years without adequate scientific review for impacts on human health and the environment (Krimsky 4, Schapiro).       

That’s why physicians, nurses, and health researchers who document evidence of harm linked to manmade toxic chemicals are so important. Researchers examining umbilical cord blood have demonstrated that babies are born “pre-polluted,” with hundreds of manmade toxic chemicals in their bodies (Morello-Frosch, et al. 12466). This followed an Environmental Working group study of infant cord blood that found more than 230 chemicals in a newborn’s blood (Body Burden). There is no ‘control’ group of babies born without chemicals in their bodies with which to compare. With hundreds of manmade toxic chemicals in our bodies, it is exceptionally challenging to know which ones are causing harm and how much harm occurs due to the combination of all those chemicals (Silens and Hogberg 630).  Add to that the attacks from industry and their ‘downstream’ users on researchers who are documenting harm, and you have tremendous challenges in diagnosing illnesses linked to toxic exposures (Michaels 35, Oreskes and Conway 151). Read more about how difficult it is for toxicologists and epidemiologists to “prove” that manmade toxic chemicals cause illness in the “Complexities” essay in this module. 

Even when we can directly make connections between exposure and illness, it can take years for the complete health impacts to become known (Boekelheide et al. 1353). This may have happened with my daughter Sarah when her thyroid became impaired. I look back and realize that I may have unwittingly dosed my daughter with a synthetic sex hormone, bisphenol A (BPA), when she was a baby. I had no idea that BPA – an endocrine disrupting chemical (EDC) – lurked in the can linings of the baby formula and plastic baby bottles we used. I may have unknowingly contributed to my daughter’s thyroid becoming impaired later in life with exposure when she was at a vulnerable age.

When the thyroid gland stops working properly, it can trigger illness, including obesity, impaired neurodevelopment in utero, failure to carry pregnancy to full term, autoimmune disease, and more (Serrano-Nascimento and Nunes 1). Discoveries are emerging as environmental health researchers identify even more illnesses linked to thyroid dysfunction (Calsolaro 1). In the United States, thyroid cancer has “spiked” among women (Reynolds) and has risen “by almost 6 times in Canadian women and 5 times in men” during a 43-year study (Topstad and Dickenson E62). 

Once I started working with health researchers investigating the impacts of BPA, clues to my daughter’s thyroid problem, as well as insights on the rise in thyroid diseases, came to light with many peer-reviewed studies (Pearce, Elizabeth and Braverman 802) providing evidence for the hazard. Years after the discovery of Sarah’s thyroid disease, environmental health advocate Bobbi Chase Wilding from Clean and Healthy New York said something on a conference call that helped ease the guilt I felt: 

Why do we mothers have to be responsible for knowing the science and the chemistry of the foods we buy from the stores? How is it that the responsibility for protecting our children’s health from invisible and unlabeled toxic chemicals falls on us? Why do we have to feel guilty?

Why, indeed. This is a wicked question aloft in a sea of broader issues.

Frontline Workers in Combating Environmental Toxins

While some governments such as Canada, the European Union, and the U.S. have a process for assessing toxic exposures for workers that enable health care professionals to fill out forms to document exposures, (“Environmental Illness,” “Dangerous Substances,” “Toxic Industrial Chemicals”), for everyone else –  nurses, physicians, and health researchers – their main recourse for reporting what they see as suspected health impacts from environmental exposures are local public health departments that are, themselves, often “insufficient” to assist afflicted communities (Vandenberg, “Addressing,” 122). Yet health professionals are often the first to become aware of and pursue knowledge about illnesses and injuries arising from nonwork related toxic exposures; some are keen observers of the relationship between their patients and their patients’ environments. Spurred on by what they see on the front lines of their work, they often launch into investigations of these problems and seek solutions of their own. 

Because children are most vulnerable to toxic exposures (Hauptman and Woolf e466), pediatricians are often among the first medical professionals to recognize health impacts from environmental exposures. One of the leading pioneers in pediatric environmental health, Dr. Philip Landrigan, has devoted his career to raising awareness among other physicians and health researchers. A public health physician and epidemiologist, Dr. Landrigan is director of the Global Public Health Program and Global Observatory on Planetary Health at Boston College, where he uses “the tools of epidemiology to elucidate connections between toxic chemicals and human health” (“Landrigan,” Biology Department). His early research revealed the toxicity of lead for children “even at very low levels” (Ibid). This prompted the removal of lead from paint and gasoline around the U.S., reducing lead levels in the average U.S. citizen (and perhaps many others in the world) by 90% (Ibid). His work documenting harm to children from pesticides played a part in reforming U.S. pesticide policy. I saw the power of Dr. Landrigan’s efforts firsthand working with staffers with either U.S. federal or state legislators who considered Dr. Landrigan’s studies to inform policy. While in his position as co-chair of the Lancet Commission on Pollution & Health (between 2015 and 2017), he gathered a worldwide team of experts who identified pollution as the cause of more than 9 million deaths annually; they labeled pollution “an existential threat to planetary health” (Landrigan, “Environmental Pollution”).   

In their seminal 2017 work, with added significance since it is the world’s oldest peer-reviewed medical journal, The Lancet, published the Lancet Commission on Pollution and Health report, in which they state: “Pollution endangers planetary health, destroys eco-systems, and is intimately linked to global climate change” (Landrigan et al. “The Lancet Commission’” 462). The esteemed scientists and physicians on this Commission identified ubiquitous global toxic chemical exposures such as lead, mercury, chromium, DDT and more as culprits that have “… repeatedly been responsible for episodes of disease, death, and environmental degradation” (Ibid.).

Few physicians understand this more deeply than Dr. Paul Saoke of Physicians for Social Responsibility – Kenya. I first came to know of Dr. Saoke when I was asked to help produce a U.S. Congressional briefing to try and convince legislators to not allow U.S. tax dollars to fund a scheme to spray DDT in several countries in Africa. The story of this experience can be heard in the “DDT in Africa” podcast in the Explorations section of this module. Later, I was able to meet him in person and we’ve stayed in touch ever since. He was very gracious with his time for this project. Dr. Saoke explained to me how toxic exposures from plastic waste is such a ubiquitous hazard in his country. Plastic is so bountiful in Kenya that some people use it as fuel for cooking, exposing them to carcinogens. The poverty is so severe that it is challenging to dissuade people from burning it. Dr. Saoke explained the outcomes of this practice:

… you can see this direct correlation between the environmental origins of cancer, especially as it relates to the release of dangerous chemicals into the environment, and the cancer incidence in a third world country like Kenya. So, what we’re dealing with here is multifaceted. We are dealing with the issue of educating the public so that they get involved in safe environmental practices, so that we reduce the cancer incidences. And then we’re also involved in trying to manage the cancer incidences with cost resources. (Paul Saoke)

Dr. Saoke has worked tirelessly on policies about chemicals that travel long distances, called Persistent Organic Pollutants (POPs). POPs last a long time, drifting north from where they are applied (Hung 1577). POPs are not well-known, and yet policy work on POPs is meaningful for all life on earth due to their mobility. No one is immune. And most all of us are complicit in the creation and use of these and other man-made toxic hazards. They originate from somewhere. In the “On the Fenceline” module, we hear from Yupik elder Vi Waghiyi and biologist Pam Miller about how Indigenous communities in the Arctic are experiencing sickness, suspected of being triggered from POPs chemicals applied in the Global South in addition to exposures from long buried military waste in their communities on St. Lawrence Island in the Bering Sea.. This is corroborated by other researchers (Cordier et al. 10). 

Health care professionals on the ground where the pollution originates work to stop it while attending to their sick patients. However, economic, and political influences hinder regulations on chemicals. When Dr. Mark Mitchell was Director of the Hartford, Connecticut Department of Public Health, political pressures leaned toward removing regulations for public safety, not increasing them. In the podcast, you can hear him describe the increasing awareness among Black physicians about the links between their patients’ illnesses and environmental exposures. Even so, Dr. Mitchell, whose responsibilities included the health of all residents of Hartford, expressed his frustration about the influence of politics on what should have been a basic scientific and health-centric identification of environmental exposures that were making people sick from a landfill. 

Dr. Mitchell is now Emeritus Professor of Climate Change, Energy, & Environmental Health Equity at George Mason University’s Center for Climate Change Communications. He chairs the National Medical Association’s Council on Environmental Health and Climate Change (The National Medical Association was founded in 1898 in response to the American Medical Association denying Black physicians entry and boasts more than 50,000 members today). In this work he created a mnemonic (a way to remember something) to help health providers determine if their patients might be experiencing health impacts from climate change. It is called HEATWAVE:

Heat effects; 

Exacerbation of pre-existing heart and lung conditions; 

Asthma; 

Traumatic injury caused by climate-related severe weather; 

Water- and food-borne illnesses;                                          

Allergies; Vector-borne diseases, such as West Nile and Zika; 

Vector-borne diseases, and 

Emotional and mental health impacts from experiences like loss of property or life due to climate-related disaster.  (“Testimony”)

Dr. Mitchell’s mnemonic is being adopted by health researchers working on climate and health all over the world. This is an example of the nature of EH professionals: they innovate, share their work, and help make big changes that support protections for all of us. 

In Boston, Dr. Sean Palfrey at Massachusetts General Hospital also saw impacts from environmental exposures with his patients. In his observations, lead was the culprit, and it was hurting children. Lead is a neurotoxin associated with learning disabilities, lower IQs, and other neurological problems that are seemingly on the rise (Aschner 142).  I contacted Dr. Palfrey to ask for a comment for a news release for the Campaign for Safe Cosmetics about the discovery of lead in certain types of red lipsticks (Reuman). Pregnant women who wear this kind of lipstick (most often the brighter red shades), are unwittingly dosing their fetus with lead during vulnerable stages of development for the fetus’ brain and nervous system. Dr. Palfrey stays on top of research about health impacts from lead exposure, so he is a great resource for reporters. He did not hesitate when I asked him to be the expert for our news release and generously gave his time to speak with the reporters who I was able to interest in the story. 

The 2007 report on lead in lipstick by the Campaign for Safe Cosmetics may have sparked a similar study by the U.S. Food and Drug Administration (FDA) in 2009 (Hepp et al. 405). We contacted reporters when the new FDA study came out (which reported higher levels of lead in lipstick than our 2007 tests). Amanda Gardner, a reporter with coveted news content provider Healthday, took us up on our suggestion to contact Dr. Palfrey as a physician expert. This is the quote he gave her: 

If you put this on your mouth every day, or little kids’ mouths or when you’re pregnant, is this small amount of lead building up in a way that would affect infants, fetuses, and young children significantly over time? … it could, so why do it? (Gardner)

Dr. Palfrey went so far as to assert that there is no safe level of lead. Considering recent revelations of lead contamination from aging water pipes found in Flint, Michigan, Jackson, Mississippi, and many other communities, the presence of lead is a tragic reality that has put the cognitive capacities of many generations in harm’s way. In a report to the City of Boston years ago, Dr. Palfrey implored local officials:

• Educate every parent, every landlord, every realtor that lead is still a problem and know risks, signs, and symptoms.
• Screen, routinely, at 9 mos, 18 mos, and yearly till 6 years of age if child remains with elevated levels or at risk.
• Screen immigrants up to 10 years of age who come from rural areas and/or developing countries where gas is still leaded, children and adults work and play around lead.
• Insist that any housing unit a parent rents or buys be deleaded.
• Advocate that all other places children are (day cares, schools, shelters, churches) be deleaded (some funds available, but we cannot require this to happen).
• If we are not insistent, this problem will not be solved. (Palfrey)

            One might ask: Did the petrochemical industry know that their products, primarily gasoline and paint, contained lead, a substance that lowers IQs in children and impairs neurological systems? According to Kat Eschner, writing for the Smithsonian, the answer is yes (Eschner). With this historically callous corporate view toward public health, it perhaps should not have been surprising when the chemical industry attempted to create a rule within the U.S. Environmental Protection Agency (EPA) that would codify intentionally dosing pregnant women, infants, incarcerated men and women and “orphaned” children with pesticides (Sargent). Lobbyists from Dow Chemical and Bayer wrote these points in a note during a meeting with a politically appointed EPA official and staff scientists. Learn more about this in the “Brief and Recent Environmental Health History” essay.

Many health professionals are understandably invested in figuring out how to prevent illness in the first place by helping to create regulations and laws to protect the public. One such organization is the Alliance of Nurses for Healthy Environments (ANHE). Their e-textbook, Environmental Health in Nursing, Second Edition, is an Open Source (free) textbook that supports nurses to understand the environmental health hazards and their links to health impacts. (See the Explorations for a link). Dr. Barbara Sattler is a co-founder of ANHE. When I asked her what led her to working in this field, she responded that she wanted to figure out how to keep people from getting sick in the first place: “We can keep repairing people, we can keep repairing our environment, or we can prevent them from being damaged to begin with” (Sattler). She first started seeing workers who were sick from mysterious exposures, and this started a lifelong dedication to working for the ‘Right to Know’ policy that workers, consumers, and residents of a community – everyone – has a right to know what is in their environment and the products they use, and how their health might be impacted by exposures. Unfortunately, many companies do not label their products with lists of the harmful chemicals in them. 

One of Dr. Sattler’s foci has been environmental hazards that threaten nurses specifically. She is working with a non-profit organization to poll 1,500 nurses about the impacts on their health from working in environments where they are exposed to toxic chemicals and radiation. They found that nurses have very high rates of asthma, and researchers believe that this may be triggered when nurses have to clean counter surfaces repeatedly. Her investigation found that janitors have high rates of asthma, too, posing the question: Are cleaning products triggering asthma in janitors and nurses? (Barbara Sattler)

Dr. Sattler’s team also looked at nurses’ exposure to pharmaceuticals. Nurses often must crush or split pills for patients. This results in particulate from the pharmaceutical going into the air and leading to potential inhalation or dermal absorption, so this is another environmental health hazard that Dr. Sattler, and her team are researching. 

Like Dr. Mark Mitchell and many other health care professionals, Dr. Sattler believes that the health of her patients is enmeshed with the health of the planet, climate change, and extreme weather events, along with basic factors, such as food safety and security. With so much work, I asked Dr. Sattler what keeps her going when the work to prevent harm seems so daunting. You can hear what she says about that and more in the podcast for this module. 

One of Dr. Sattler’s foci has been on what environmental hazards threaten nurses specifically. Dr. Sattler is working with a non-profit organization to poll 1,500 nurses about the impacts on their health from working in environments where are exposed to toxic chemicals and radiation. They found that nurses have very high rates of asthma, and researchers believe that this may be because nurses are always having to clean patients and counter surfaces repeatedly (Sattler). This investigation found that janitors have high rates of asthma, too, posing the question: Are cleaning products triggering asthma in janitors and nurses? (Sattler)

Dr. Sattler’s team also looked at nurses’ exposures to pharmaceuticals. Nurses often must crush or split pills for patients. This results in particulate from the pharmaceutical going into the air and leading to potential inhalation or dermal absorption, so this is another environmental health hazard that Dr. Sattler, and her team are researching. With so much work to document exposures to nurses, I asked Dr. Sattler what keeps her going when the work to prevent harm seems so daunting. You can hear what she says about that and more in the companion podcast for this module. 

Other health professionals continue to work directly on documenting manmade toxic exposures in communities. Dr. David Carpenter is based out of State University New York, Albany, where he runs a World Health Organization (WHO) lab. His team has been studying health impacts from polychlorinated biphenyls, better known as PCBs. Though banned years ago, they are persistent, and are linked to a variety of present-day illnesses, including neurological harm, infertility, hormonal disruption, and cancer (“Polychlorinated”). Dr. Carpenter shared with me how he came to understand the threat they posed. In the podcast for this module, Dr. Carpenter relays a story about people who are sick from the PCBs. I think about the myriad rising rates of illness linked to PCB exposures. Obesity, for one, is an epidemic. I think to myself, is this because of PCBs? Dr. Carpenter shared more information about these chemicals:

PCBs are a group of chemicals that are 209 different PCBs, and they don’t have all the same properties … and they don’t have all the same health effects. So, a lot of my work, for the last 30 or 40 years, has been trying to understand what PCBs do to health. I started out focused on the nervous system. Most of my work more recently has been on the chronic diseases of older age, of cancer, of heart disease, and diabetes. And these chemicals, because they, they cause induction of many different genes, they alter the risk for so many different diseases, it’s hard to understand, [how] one group of chemicals can change your IQ and your attention span, increase your risk of diabetes, increase your risk of high blood pressure, alter your sex hormones, alter your thyroid gland. And they do this because they change the expression of many genes that are important for just about every biological function. … for a number of years, we studied lead poisoning, and its effect on the brain. And then it became clear that PCBs also reduced IQ. (David Carpenter)

Dr. Carpenter has been working with the Yupik Indigenous people of St. Lawrence Island in the Bering Sea. 

2013

            “The permafrost is melting,” biologist and health researcher Pam Miller explains, as we eat lunch at a nearby restaurant there in Anchorage. “Even though St. Lawrence Island, being in the Bering Sea, is technically in the Arctic, the drums containing the toxics that the military buried in frozen ground decades ago are corroding and leaching.” Pam founded Alaska Community Action on Toxics (ACAT) and has hired me to come up and brainstorm communications strategy to support their policy work. “And so, the incidences of cancer, failure to carry fetuses to term, birth defects and more health impacts are rising even more than they already were on St. Lawrence Island.”

            Nothing like the queasiness of discussing toxic health impacts while scarfing a sandwich; an occupational hazard of working on environmental health and environmental justice issues.

            “Plus, the POPs chemicals are drifting up, right? So, the people on St. Lawrence Island also have tough cumulative exposure levels in their traditional foods,” I add, thinking about salmon, seals, and whales – traditional foods for the Yupik – contaminated with the POPs chemicals.

            Pam nods. Her eyes tell me what I already know: The health impacts from all these manmade toxics have triggered tremendous suffering for the Yupik, demonstrating a terrible legacy of disregard for Native peoples and their land that Pam – and I – as white settlers, both feel an obligation to try and help remedy somehow. Pam has devoted her life to trying to use her scientific knowledge to help stop the health impacts harm and gain justice.

            Returning to ACAT, I go into Pam’s office to grab my laptop. I’m due for a meeting with Vi Waghiyi, a Yupik elder from St. Lawrence Island. I look and it’s not there. I think, “Maybe I’m so tired I forgot where I put it,” and start looking around her office to see if I had plugged it in somewhere else. Pam walks in.

            “What are you looking for?”

            “My laptop. I left it charging right there on the shelf.” I point to where I’d last seen it. Pam and I search her office and the entire place. Panic wells up inside of me, pooling in my throat. I work remotely so ALL my work is on that computer, my entire livelihood. (No “Cloud” per se back then). After questioning staffers, we determine that a stranger has been in the building and must have stolen it. Trying to not cry, I am speaking with a police officer on the phone, when one of Pam’s staffers tells me Vi is waiting for me in the conference room. Grabbing pen and a notepad, I make my way to the conference room, steeped in despair, and greatly distracted.

             Vi is standing there, waiting. Wiping tears, I apologize for being late.

            “I am sorry your laptop was stolen,” she says gently. “But we are having babies being born without brains on St. Lawrence Island and we need help.”

            The enormity of what Vi says halts my emotional downward spiral of self-pity over my stolen laptop. As if struck by lightning, I am suddenly grounded. Sitting down as if pushed, I realize that the loss of my laptop means nothing, absolutely nothing, to me now. The only thing that matters is trying to figure out how to support Vi’s work. 

           I tell this story to demonstrate the importance of Pam Miller’s, Vi Waghiyi’s and Dr. Carpenter’s work for the people of St Lawrence Island and the rest of the world. A biologist, Indigenous elder, and physician are each conducting important scientific health research.

Other health professionals work within medical schools studying links to illness from chemical exposures. Dr. Tracey Woodruff is the Director for the Program on Reproductive Health and the Environment at the University of California, San Francisco. In our conversation, she emphasized the conundrum that there are so many manmade toxic chemicals in our bodies that we don’t know what the impacts are in a cumulative manner. She also mentioned other factors such as stress and poverty that can figure in triggering illness combined with the “body burden” of multiple toxic chemicals: “We know that people have dozens and dozens of these chemicals inside their body … that’s what cumulative exposure is in the narrow sense related to chemicals” (Tracey Woodruff). Dr. Woodruff and her team have been instrumental in documenting reproductive health impacts from toxic exposures (Woodruff, “Science-based”). Their studies call for increased protections to be included in policy.

When you stop and think about it, it makes perfect sense for hospitals to look inwardly to see if they are inadvertently deploying practices that affect people who work there as well harm patients. For example, environmental health advocates at Kaiser Permanente (KP) realized that the polyvinyl chloride (PVC) tubing and drip bags they were using might be leaching dioxin into their patients (Gerwig 2). Dioxin is one of the most carcinogenic substances yet discovered (Kurwadkar 90), and it can trigger cancer and other serious illnesses. Kathy Gerwig was Vice President of Employee Safety, Health, and Wellness and the Environmental Stewardship Officer at KP when she realized the hazards from PVC products. As a result, Kaiser ordered their drip bag suppliers to make drip bags and tubing out of something less toxic, or they would not buy the bags. The suppliers innovated and came up with less toxic drip bags and tubing, and KP subsequently banned those made with PVC (Gerwig 2). You can find a link for the seminal book Kathy wrote for hospitals, Greening Health Care, How Hospitals Can Heal the Planet (Oxford University Press), in the book section of this module’s Explorations. 

The innovations made by Kaiser seem to remain somewhat siloed. When I have the rare cause to be in other hospitals, I look at their PVC drip bags and tubing. I wonder about the likelihood of the bags being PVC and leaching dioxin into patients, and I also think about having toxic flame retardants in their curtains and furniture. Another invisible exposure hazard is ubiquitous non-ionizing radiation from all the wireless technology (more on this from Joel Moskowitz in the podcast for this module) they use. I marvel at hospitals’ blind eye for how they might contribute to illnesses and injuries among staff and patients. I am always tempted to suggest to hospital workers that they connect with Health Care Without Harm (HCWH), the group that supported Kathy Gerwig and others on raising awareness in hospitals and health care settings. HCHW assists hospitals with identifying exposure hazards and figuring out how to replace them with safer substitutions.  The link for this group can be found in the Explorations section for this module.

While the folks mentioned so far are focused on exposures from manmade toxic chemicals, others are working on a relatively more recent manmade hazardous exposure: non-ionizing radiation from wireless technology. At the University of California, Berkeley, Dr. Joel Moskowitz is the Director of the Center for Family and Community Health at the School of Public Health. Early in his career he was concerned about illness from tobacco, alcohol, and harmful drug use. Today, he has compiled every peer-reviewed study on the impacts from non-ionizing radiation. Dr. Moskowitz believes that toxic chemical exposures are made worse by non-ionizing radiation, and that emerging science is documenting health impacts. He is not alone in this concern. Dr. Martha Herbert, a neuroscientist at Harvard, is researching the connection between wireless radiation and autism (Herbert). Silicon Valley surgeon Dr. Cindy Russell started a group called Physicians for Safe Technology, which has listed all peer reviewed health impact studies on their website (Russell). University of California San Diego researcher Dr. Beatrice Golomb has identified links between non-ionizing radiation and the “unexplained” debilitating illnesses at the American Embassies in Cuba and China (Golomb 2882-2883). Hundreds of other health professionals worldwide signed a letter asking for protection from wireless technology hazards, called the EMF Scientists Appeal; it was sent to key agencies in the United Nations in 2015 (EMFScientists). In September of 2023, while working on this research, government science authorities in France banned the IPhone  12 for having dangerously high radiation levels (Rigby and Coulter). Why are so many physicians and scientists concerned? One issue that has emerged is that nonionizing radiation weakens the blood brain barrier, making it easier for manmade toxic chemicals already in our bodies to access the brain (Salford et al. 881). Dr. Moskowitz explains: 

[nonionizing radiation] interacts with other chemical toxins, these exposures, increasing our risks to adverse health, harm from these other chemical exposures. For example, even very low intensity exposure to radiofrequency radiation can open the blood brain barrier. So, if you have low levels of chemical toxins in your circulatory system, they can now penetrate your brain and cause brain tumors. (Joel Moskowitz)

Dr. Moskowitz has been collecting and analyzing hundreds of peer reviewed papers on health impacts from nonionizing radiation. He reports that researchers 

… found significant evidence [of] reproductive health effects … in both the male and female, to sperm, harm to the fetus, increase miscarriage rates, variety of cancers including, besides brain cancer, cancer of the thyroid and salivary gland, [and] breast cancer … we’re faced with a global challenge. (Joel Moskowitz)

Each participant in this project echoed Dr, Moskowitz’ declaration that manmade toxic exposures present global challenges. Whether in Kenya, Canada, the U.S., the U.K., or elsewhere, another issue I hear from health professionals who are not already involved with environmental health is that they feel so overburdened attempting to treat patients within their respective broken medical systems that taking on additional work to understand health hazards from toxic exposures proves overwhelming. 

There have also been efforts by the polluters to discourage health care providers from making their discoveries public. For example, when I was working on the reform of the U.S. Toxics Substances Control Act, on one conference call, I heard an industry lobbyist proposal making it illegal for health care providers treating communities for toxic exposures to make public information about the chemical if the information was obtained from the U.S. EPA. This law was meant to protect proprietary information about the offending chemical, also known as Confidential Business Information (CBI). The penalty mentioned on the call was to be $10,000 and up to five years in jail. Currently the penalty for anyone disclosing chemical CBI is up to one year in jail and an unnamed fine (Access). Learn more about this in the “What Instead?” module.

Elements within the disciplines of toxicology and epidemiology that comprise the major conundrum for health care professionals can be found in the “Complexities” essay. Key among these are identifying what a person has been exposed to and how, and the timing of when they were exposed to it. How can health professionals treat a patient who may be experiencing health impacts from toxic exposure if they can’t identify which toxic is triggering the illness or injury? Or if there is a concoction of multiple exposures triggering illness? What if the exposures happened in utero and now the adult patient is exhibiting symptoms from that exposure? Even more existential: what if a woman’s grandmother was exposed and this is a factor in the granddaughter’s obesity, reproductive system disturbance, and subsequent risk for breast cancer? This was demonstrated in research from the Public Health Institute and has been supported by additional studies (Cirello et al.1485). Knowing about which exposures and when they occur is important. For example, in the case of my daughter and her thyroid disease, she knows that she must be disciplined in taking her medication and that she must be conscious of eating too much of estrogenic foods such as soy. Years later, my older daughter, Becky, discovered that her thyroid had also become impaired. She is on lifelong medication as well and is cautious about potential BPA exposure. Disturbingly, emerging studies tell us that patients with existing cancer would do well to try and stay away from BPA because it is linked to triggering cancer and making existing cancer more aggressive and (Gao 1).

Another shared condition among health care professionals who grapple with environmental health hazards is that it is very tough work. When interviewing participants, I can feel the emotion and empathy for the suffering of the people they study and treat. This is a heavy load to bear and deepens my admiration for the work they do. They deserve all the government and public support we can muster.

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