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TOXIC SUBSTANCES IN OUR ENVIRONMENT - CAN WE MANAGE THEM SO THAT THEY DON'T MANAGE "TO HARM US? Marvin A. Schneiderman, Ph.D. Clement Associates, Inc., Washington, D.C. April 1981 I want to talk .today about health and the environment'- from my own narrow point of view - which means that I~ll talk a lot more about cancer and less about birth defects, mental retardation, and even less about the emotional instability that an unstable environment can help foster. \ For some years I felt (minor)~uilt about being male and thus, I thought, not subject to the health p~oblems related to children and child- bearing that women were obviously subject to. No one ever considered removing me from a job because I was between the age of 16 and 60, and thus might be possibly damaged by something on the job that might damage one of my offspring. The most effective s'creening programs we proposed to detect cancer .early were programs directed at women. The newest chemic@l contraceptive techniques were ones used by women. The pill's ~ide e(fects affected only women, of course. B~'t those days are largely ended. I don't have to have those guilt feelings any longer. I can be like Jeff in the "Hello Carol" cartoon strip. I don't have to add guilt to my problems. GROUP, WE- II ~E~" A | I AREN'T OPPRESSEDIi I~ EHBARRASSINGLY EASY ~ I DON'T ADD 6UILT I HAVe.EqUaL- IA SOC,~L I I yOU flArE NO I B COHPARED TO REAL .. I~ / TO mY PROBLEt'iS. II NEED§'IS AND | I CONCEPTOf REAL I ~ HINORITIES DENIED i~l " EHOTIONI~L! I OPPRESSION! J I] RIGHTS!HOUSING!JOBS! ~ Jane Brody, writing in the New York Times only a few weeks ago, reportec that sperm were very sensitive to environmental insults. A teratologist I know told me at dinner in Mid-April that adult males were adversely afrected my the same- low blood level of lead that damages the foetus. Tl05390008

-2- The contamination of the ground water by organic chemicals in the part of Long Island where I once lived has led to closing the wells that provide water for both men ar&d women. But the final guilt - relieving bit of news appeared in the Washington Star on April 21, 1981. If I was ever concerned that I was placing all the burden for responsible birth control (when I was younger) on my wife, I could now feel relieved. The headline on that article read: "Scientist Calls Plastic Water Pipes Equal To A 'Chemical Vasectomy' " \, scienti Ciii P l stic Water Pipes Equail a 'cher6i al . Vase omyi . . , :.~ • . ..... :.. ~'.~ ~.:~ - . .. • . ~C~, ~lif. (UPI) -~,,:: ~ikel7 there ~ill ~" ~read or~to~ t~ indi~te plas~c water ~ ~roughout the ~te. You'd want ~o pi~ cons~der~ for w~despread':~, ~ pretty certain that~ou donX resideotial u~ in Califo~ia ma~. ~use a massive ~eril~om".,.. - . . ca~e" slerili~ and cancer in hu- - ~e" comm~i~ ~l~" received a ma~, a ~ate commi~i0n was told . letter from L Donald Te~er, y~erday ' . , , , ~ ~'~¢~ ~ ~,;~'.'0~ ~or of ~e Depar~ent of Ho~ing _ • -~ ~W~,~ .... y~o., .~s.y .... and Community Development, and a ~mmum~ ~vempmen~ xema~v~ tel " "epnooe ~n from s~le ~xre mar.- ]y approved Nov 24 use of ~e ~ly. • . ..... " ..... - shal Phil Favro Bolh ~ked for f~.. outy~ene p]~, maouxacxurea oy , ther stud : .... ~ell~emi~Co.. " : -.. ..... ~ y ol.t~e.p]~. ~ore ~e ~mmi~ion la~er delayed fl- ,appr°v~ ' .. nal a~o~on for expanded ~ : But'Shell's" la~er: William. Hol- of the pi~ in ~IHornia to allow Hma~, told ~e commi~ion more ~me to co~ider ~teotial S~hn gathered all his data from one health hazer&.'" .: ¢ ." ". ~'~.~t d te~ resul~ and ~at ~o~er" Ia y~terday's hearing, ~ate C~n-. ']a~ra~o~, f~nan~ed by ~ell, ~mer ~fairs'" Director Richard..~alediy aas founa no~ing lining S~hn ~id tes~ by ~e ~lifo~oia "~ t~ ~ipe In ~ocer.- ~, " ' , ~al~l ~borato~ ~od)~ed a ~ " ~ , " ...... ~fore Ho]limao's {e~mony, My-. chemi~l ~own~ DEHP, whichh~ "r~ MoskO~, chai~aa "of ~n found to ~ ~oce~ rood ~':. Hq~ng and Communi~ ~velo~ rili~ in la~rato~ animals, may ~-... ~ent Co~mi~o~ ~iO he had d~id- ~ ~.h~do~ quao~.~ ~e "~.to r~uire ~u~her ~dy ~fo~ pi~ - " " '- -" ;" :- ~e pi~ w~ au~oriz~.~ ~at~ "One ~ien~ h~ dub~ D~" " mehl angere~ Hollim~ who ~id it ~e ~uiv~ent of a c~mi~ v~- "preju~c~ ~e other ~mmi~oo- "foray," S~hn ~i& "~ you do ~ " e~"~fore~e~hmdach~tovot~ of ix o. We've progressed from the lead pipes that may have poisoned the Romans, to the wooden pipes that provided fertile breeding grounds for bacteria, to the iron pipes that gave us rusty brown water, to asbestos - cement pipes, to community birth control through leaching plastic. Tl05390009

-3- Public Health people have long argued that the. most effective public health measures were those carried out by the community - clean water, good sewers and waste disposal, etc. But only in Science Fiction have I seen suggestions that population pressures be reduced by adding con- traceptives to the public water supply. With respect to modern thinking about reproduction disorders in both men and women, some of my colleagues have put together some in- formation on possible environmental hazards. Here's a list of some of them -.arranged according to when in the process they occur. The Range of Possible Reproductive Effects of Before Conceptio_n ~enstrual disorders A~e at menopause Impotence in males • Reduced libido in males and females Infertility ~perm disorders Other genetic da~.age in males and Hormone imb al ~nce - in males & females Harmful "~ent s \ During Pregnancy Greater toxicity of chemicals to mother and to "embryo or foetus Spont ~neous abortions DamaEe~..to ~enes and other cells Still births Slow growth of foetus After Delivery Premature births Low birth weight Birth defe~ts Mental retardation Premature death Behavioural disorde~ C~ucer DAVID G EE HEALTH ANI~ SAFETY OFFICER (RESEARCH DEPARTMENT| General and Munlcipal Workers',. Union, • Thorne Hpus~." Ruxley Ridge. Claygate, Etcher, Surrey. KT10 0TL Telephone: ,ESHER 62081 This brings me to considerations of the environment - and what it consists of. The environment that can be controlled both personal, what I do with respect to myself, how I dress, what I eat and drink, what I smoke - if at all - and impersonal, the whole world around me, about which I am able to exercise little or no control. To me, the key to thinking about the environment lies in that word control. What can I, T105390010

-4- of myself, with not much help from anyone else, control? And for what things do I need lots of help from other people, from the government(s), from society in some broad sense to control or modify. I gave some examples earlier. At one time I would have thought that I had complete control -(Or nearly complete control. If I lived in Connecticut at one time I would have had trouble) in controlling conception. Now some of that control may have been taken away from me - what with plastic water pipes, or perhaps DBCP - if I worked on a job where I was exposed to DBCP. At one time, we could drive our well pipe 20-25 feet deep into the sandy soil of t~e glacial outwash of Long Island, and if we chose a site up-hill from our ~arbage dump we could get good, clean, (nearly) bacteria - free and equally organic-chemical carcinogen free water. If I-still lived in Amityville that choice might no longer be available to me. I still do have many choices, of course. I can choose to not smoke cigarettes. I cad choose to eat (slightly) less fat meat - although it might sometimes have been hard tg,. avoid diethylstilbestrol. I could choose to live on a farm, and not work at what I have been trained for - where the only employment is in the cities. I could choose - if I had enough money - to not drink the city water. It would be only a short term solution to choose to not breathe the air. Now that there has been a public health awareness for almost 20 years, and some small government action, I can sometimes find a restaurant where I can have a meal free from cigarette smoke. Now that there has been public awareness, and some government action, I am breathing less lead -c~ntaminated~air (and less of other contaminants, too) as I walk about thecity that I ~Live ~ah~ worm in. I am still upset to see the smgg in Denver and Salt Lake City that I didn't remember seeing when I first visited those cities perhaps 30 years ago. And in Maine and Vermont and Oregon, and some other places I can take pleasure in the fact that the roadsides are not littered with beer cans and bottles. And I can recall that some of the pleasures of clean envir- onment are aesthetic as well as health-promoting. T105390011

--5-- ; When I think of health I see many good and positive things. I think we, in this country, are enjoying better health than ever before in our history. Our .life-expectancy has been increasing - rapidly. The infectious diseases have been declining, rapidly, so rapidly that -=e they almost seem to be disappearing. Infant mortality is declining - ~ure #4 in part, by the way coinciding in time with the easier access to legal sanitary, aseptic therapeutic abortions as well as with better pre- natal care and improved local government.services. The diseases of the ~e 'heart have been declining - rapidity. Only two important groups of diseases, gure #5 or causes of death, have continued t,o increase. After correcting for age/race/sex - so that the data from year-to-year might be comparable - only cancers, and the chronic obstructive pulmonary diseases have shown continuing increases in the last decade. However, 1980 was not a good year with respect to health. Some of those good trends I talked about halted, or were reversed. One would hope~ temporarily. Among deaths-.due to medical causes, diseases of the ~ ~eart increased 3.6% from 1979 to 1980. Malignant neoplasms, l.5% (the gure 6 largest increase in some time), chronic obstructive pulmonary diseases 10.1%, and nephritis and related disease 6.8%. The NCHS says "... these provisional data ... should be interpreted with caution. [They] are subject to sampling errors and the effects of influenza epidemies ... in early 1980 and in December 1980: there was do ... influenza [epidemic] ... in 1979." From time-to-time there have been suggestions that increases reported in cancer mortality may not be real, but may be the result of better medical care, leading to better diagnosis. There is the possibility that because an association between lung cancer and cigarette smoking has been established that lung cancer is now over-diagnosed. (In case of doubt about the primary site, if the physician knows the patient to have been a heavy smoker it may influence him to diagnose the cancer as primary to the lung). It can't all be diagnosis, however - or at least the changes in diagnosis cannot have been uniform. NCHS reports increases in respiratory cancer death rates from 1979-1980 - but also reports decrease in Breast Cancer mortality, and in cancers of the digestive organs and of the urinary organs. TI05390012

-6- An increase was also reported in leukemia deaths despite the substantial improvements in the treatment of childhood leukemias. Thus, we must look at th~ data with caution. Among the largest increases in cancer were those for cancers of the respiratory system. Among the non-cancer deaths, the chronic obstructive pulmonary diseases increased most. Could all these increases be due to cigarette smoking? Some people seem to think so - but cigarette smoking by adults has decreased among men from over 52% in 1955 to less than 37% in 1979, and among women from 33% in 1965 to 28% in 1979. During this same time • filter cigarettes captured more a~d more of the market; the average tar and nicotine content (as well as the, tobacco content) of cigarettes decreased - and the smokers were dieing off more rapidly than non-smokers. (Cowell and Hirst estimated that a man,age 32,who smoked had a 75% chance of dieing before age 80, compared to the non-smoker who had just about a 50-50 chance of living to age 80.) The lung can.cer rates do reflect some. of these changes in smoking and in cigarettes. Rates have a.ctually declined for men under 45, and the biggest increases have been among men in the older ages - where, proportionately there are fewer smokers. Black men started smoking at later ages than whites, and are reported to smoke fewer cigarettes (about 25% fewer, on the average) and have higher lung cancer rates of all ages. all of which leads me to believe that there is something more to lung cancer - and probably other chronic lung diseases - than cigarette smoking. (Although I believe that cigarette smoking is the largest sin@le • cause of serious illness in this country today.) What might this "something else" be? I think there are several some- thing elses. There's some i~dustrial exposure, from asbestos to synthetic organic chemicals; perhaps some arsenic or cadmium, too - and there are the likely urban exposures, in addition to, or apart from the smoking and industrial exposure. E. Cuyler Hammond and his associates at the American Cancer Society have followed a million men and women for many years now, to find what they died of. They sorted them out by where they lived, how much they smoked, and if they worked at a job likely to pose some lung cancer risk. The figure shows Hammond's data - recomputed by Joan Goldsmith of the Ben Gurion University of the Negev - sorted by place T!05390013

-7- of residence - rural, smaller cities and larger cities. Two things are clear. First, the occupationally exDosed men have higher lung cancer rates than those not occupationally exposed - for every, residence area. The excess is about 14%. Second, the persons living in the large urban areas had higher lung cancer rates than persons living in the less densely populated areas. The attzibutable risk for this difference is about 10%. As the tail of the "occupationally exposed"line shows, there may even be an interaction between occupation and urban exposure. Looking at specific measures .(SOx s and benzene- soluble materials) Hammond et. al.h,, reported no correlation between what they called measures of generalized',air pollution and l,~ng cancer rates Yet, there's something there in the larger cities that is associated with higher rates. This urban effect has been seen many times before, and some people have ascribed it to population density (That's like saying you don't have a stomach ach~ but you do have acute gas{ric distress. For explaining medical things, Latin is better than English, and Greek is even better than Latin.) There's nothing in population density per se that should cause lung cancer - so population density must be a surrogate for other things. Perhaps automobiles per square mile, or automobilies per unit population (Greek for "per person"). Automobiles themselves do not cause cancer either - but perhaps some things in their exhaust emmissions might. In Great Britain, following the Clean Air Acts of the late 1950's there were reductions in lung cancer - first in London, in the 1960's, and later in the provincial cities. Roughly about the time the Clean Air Act went intoeffect the tar andnicotine conte~t of British cigarettes began to decline - and one now has a choice of explanations for the decline in British lung cancer. Clean air or less hazardous cigarettes. Julian Peto tells me he has modeled both of these effects, and either could account for the declines. I see no need to make a choice. But if both were causes, why didn't we see more of a decline - an addition (or, really, a subtraction) of both effects? To accept both causes - and both do seem reasonable and likely to me - one then needs an explanation of why the rates haven't declined more in Great Britain - or declined at all in the United States. T105390014

-8- The most reasonable explanation to me is that there are new hazards being added to our environment - all the time, and some of these are lung carcinogens. Thus we ar~ just about keeping thing even - some hazards being removed, and others being added. Among those being removed are some that involved a personal choice - or ability - to remove them - i.e. smoking. Among those being added are some largely beyond personal control, the organic chemicals, for example. (Figure #8) Thus, I find evidence that there are environmental exposures - more and more of a kind likely to be outside personal control that may be ~eading to the increase in age adjusted cancer mortality rates that we have been seeing since about 1960 or\1965. The burden doesn't fall equally on all segments of the population either. The greatest increases have been in black males, the next in white males - and the least, despite substantial increases in lung cancer - in white females. With respect to overall mortality, the 1979-1980 changes were: Whites Males +2.0% Females +3.8% Others Males +3.2% Females +6.3% If there are increases related in large part to things beyond in- dividual control, then I ask, "How can they be controlled?" How can standards for control be set? Since individual actions wou.ld not seem to be operationally possible, Is . this the place for socially-based action? If we are to have societally based action, what can it be? And how much? One recommendation I offer is for industrial exposures. I sho.uld like to see standards set - and carried out, of course - that would lead to industrial workers having eventually the as teachers - such as university professors. (Figure #10) There have been many recent suggestions for using risk/benefit analysis as a basis for establishing standards - but I think they ~are premature. I think they're pushing the technology. With respect to the technology, I sometimes fee! like Dr. Frankenstein's laboratory assistant - Ti05390015

-9- having been early on involved with Nathan Mantel and others in building mathematical models for risk estimation in cancer. The National Academy of'Science has, in its report on saccharin, shown the wide range in risk estimates for just cancer that the different mathematical models lead to. Depending on the model, they found the risk for constuning the equivalent of 1 12 ounce can of "diet" soda per day to have a relative range of about 5 X 106 from the lowest estimate (Food Safety Council Model) to the highest estimate (one-hit model with no threshold). The problems of risk estimati~on are moderately well known although there are few risk estimates for iliqesses other than cancer. Now I think we need to talk a little about the problems of benefit estimation, where I think less is known. Benefits can sometimes be looked upon as risks averte~ • but not always. This warf, what we know about risk estimation might help in benefit estimation. • Consider two recent industrial accidents - the engineering safeguards involved in them'and the possible consequences of the accidents. Here I will consider benefits as ris~'i averted. The two accidents are the one a#. Seveso in Northern Italy and the one at Three Mile Island near Harris- burg, Pennsylvania. Seveso was the site of a chemical factory in the valley just north of Milan. The factory was designed for engineering safety in the manner usually done by chemical engineers. Something went wrong with one of the processes. Things over-heated; pressure built to excessive levels - and a safety valve released - just as it was designed to do. A cloud of chemicals - including TCDD apparently blew down the valley. Birds and other small animals died. Fear developed that deformed babies would be born. There were miscarriages and abortions. Choracne developed. The fear of cancer exists. A large population was evacuated and attempts were made to fence off a very large area, to remove the top soil, and to make the area habitable once again. Poli£1cal 5a££1es have followed. There is anger with the Swiss parent company - and it is not at all certain that the valley will be safely habitable in the for- seeable future. There have been some deaths. There is fear of others. Lives have been uprooted, disrupted and damaged. The total costs of the accident - T!05390016

-10- or really, the uncontained engineering design - have not yet all been computed let alone paid for. Contrast Seveso, and its engineering, with Three Mile Island. The nuclear power plant at Three M~le Island was designed not only to protect the plant -and also to protect the people living in the vicinity - and some not so close by. Suppose Three Mile Island had been built to earlier factory only engineering standards. As the core and the rods began to meet, the radioactive gases mightCould haVe vented to the atmo- sphere - to protect the plant. The radioactive water, now still in a con- ~ tainment building, would have flowed into the Susquehanna River - to flow eventually into the Chesapeake" ~ay. Would it have made inedible the fish and the oysters and crabs that grow in such abundance in the Bay? Would it have made the Baltimore Harbor, the second busiest on the East coast, next to New York, unsafe or unuseable? If the radioactive material had been vented how many people would have been affected? Made ill? Eventually killed? How many additional casualties would there have been .~n addition to Edward Teller (who, in full page newspaper ads, describe~ himself as th~ on.lycasualty of Three Mile Island? He had a heart attack after working long and hard to counter anti-nuclear arguments by Jane Fonda - he said). If Three Mile Island had not been contained and if many people were killed, and food supplies, and an important part possibly damaged, what would have happened to the nuclear power industry? Already in precarious shape, I could see it only as being completely out of business. Had nuclear power production been put out of business in the United States it is likely that it" would have had very difficult going in several other coun'trie- particularly Sweden, West Germany, and possibly France. The twenty year window we now mayhave, if we behave intelligently, to develop renewable sources of energy would likely be closed - and the curtains drawn. The pressures to insure the supplies of Persian Gulf oil - and the competition for the oil would be even greater. Our Military "assistance" programs would be greater. Our budget deficits larger. The likelihood of a war over the Persian Gulf oil considerably greater. T105390017