PORTLAND, OR—Environmental issues are inseparable from health care issues, and holistically minded physicians need to step up and assume leadership in the effort to reverse environmental degradation.
“Unless we create conditions of health and wholeness, medicine itself will be a losing battle. We need a movement for ecological medicine. Public health is dependent on the health of the Web of Life. Medicine needs to be leading on this,” said Kenny Ausubel, at the annual meeting of the American Holistic Medical Association.
This year’s conference, entitled “Environmental Awareness & Health Care” provided a rare, much-needed gathering point for environmental scientists, eco-activists, and holistic health care practitioners from diverse disciplines.
Ranging from the biochemical level to the geopolitical, the presentations covered everything from the cellular effects of common industrial toxins to the impact of industrial agriculture and excessive electromagnetic radiation. Participants had the opportunity to share not just scary data but practical solutions on the patient care level as well as on a larger scale.
A Declaration of Interdependence
Many presenters stressed the need for closer relationships between the medical community and the environmental movement. To view environmental issues as separate from individual health issues makes little sense biologically or politically. If physicians are truly concerned about the wellbeing of their patients, they need to seriously engage the environmental challenge.
“Having watched the natural/alternative health care movement for many years, one of the traps I see it has fallen into is structural. The system we are all embedded in, the dominant economic model, is focused on individual patients rather than on public health. But our health is entirely dependent on the ecosystem. There is no real separation,” said Mr. Ausubel, founder of Bioneers, a growing consortium of scientists, activists and innovators seeking to solve human problems by studying design principles inherent in nature.
He believes the holistic medicine movement would gain much-needed vitality and support if more physicians created working relationships with scientists and activists working on the “macro” level. The key is to recognize how individual health problems result from larger interpersonal, psychosocial, economic and environmental influences.
“There are no single issues. Everything is interconnected. If you try to solve an issue as a single issue you don’t get very far. Just as if you try to treat a specific symptom or organ system without considering the other systems, you don’t usually get good results,” said Mr. Ausubel, who is also a co-founder of Seeds of Change, an organization that preserves biodiversity and promotes organic agriculture through banking, cultivating and disseminating open-pollinated heirloom flower, herb and vegetable seeds.
He called for a “Declaration of Interdependence” identifying the common ground between environmental health efforts, public health, energy policy, and individual clinical practice. “Once you cross-connect, there’s more availability of problem solving, and people and energy. So map the connections between the holistic health care movement and all these other movements, and make those connections explicit and figure out who you can work with.”
For Fear of Despair
Michael Lerner, PhD, president of Commonweal, a health and environmental research institute in Bolinas, CA, and Smith Farm Center for Healing and the Arts, Washington, DC, believes doctors must renew their commitment to public health. That means addressing environmental factors that foster chronic disease.
Dr. Lerner is also co-founder of Health Care Without Harm, and the Collaborative on Health and the Environment, organizations dedicated to direct action to improve the ecological impact of medicine and health care practice.
“The essential strategies of holistic medicine have been about helping people and families to heal, and to protect themselves from a world that is falling apart. But these strategies do not engage the vested interests behind that world. And this is destined to fail. We don’t look the problems squarely in the face for fear of despair,” Dr. Lerner told the AHMA. Certainly, there’s plenty cause for despair.
But he added that, “When public health efforts have succeeded, it has only been when physicians engage in the struggle. It is only then that things get done. We need holistic public health action.”
Proving Safety vs. Proving Harm
Underlying many environmental health policy battles, particularly on matters of banning potentially toxic chemicals, is the issue of burden of proof: Should it be up to manufacturers to prove safety or does the burden rest with environmental scientists and regulators to prove harm?
In the US, policy is driven by the latter imperative, a sort of chemical equivalent of “innocent until proven guilty.” Industries are largely free to produce, utilize and sell a wide variety of chemicals for almost any imaginable purpose, until there is definitive scientific proof that those chemicals are dangerous. EPA and other agencies set “safe” limits, based almost exclusively on theoretical values from animal toxicology studies.
As a result, there are about 80,000 synthetic chemicals in current use, said Dr. Lerner. “Very few are tested for human safety. The US jealously guards its policy of allowing use of chemicals widely in the environment, challenging regulators, scientists and physicians to prove they are dangerous.”
That proving proves very difficult to do. Direct-exposure studies are unethical, and prospective epidemiological studies can take decades to complete. Plus, they’re expensive, and with no obvious commercial pot of gold at the end of that research rainbow, there’s little incentive—or funding—to do the studies.
An Eco-Science Revolution
Emerging science on the machinery of gene expression is dismantling the classical toxicology on which much eco-policy is based. Conscientious scientists are having to re-think received wisdom about the genetic basis of disease, the impact of environmental toxins and their role in disease etiology, said John Peterson “Pete” Myers, PhD, Director of Environmental Health Sciences (www.environmentalhealthnews.org), a non-profit group dedicated to increasing public understanding of environmental toxin exposures and human illness.
“We are midstream in a scientific revolution as far as how we think about contaminants and human health. Traditional toxicology and epidemiology … have underestimated low-dose impacts on human fertility, carcinogenesis, neurological development, brain function, many other things (Read Endocrine Disruptors, Precocious Puberty & Reproductive System Cancer. Click here.)
Regulatory toxicology, human epidemiology, and medicine must do a better job at incorporating the new science,” said Dr. Myers, co-author of Our Stolen Future (Dutton), the landmark 1997 book that first shed light on the negative impact of xenoestrogens and endocrine disrupting toxins on human health.
The toxicological revolution centers on four key themes:
- Some contaminants, especially those with hormone-mimicking effects, can alter gene expression at extremely low doses, challenging the classical toxicologic idea that, “The dose makes the poison.”
- High-dose experiments do not predict low-dose health impact. Some compounds produce different, even opposite biological effects at different doses.
- In most environments, mixtures of multiple contaminants are the rule, not the exception. Mixtures interact in unpredictable and potentially hazardous ways. Classical toxicology, based on single exposures, does not accurately represent the real world of environmental exposure.
- Adult diseases and sensitivities to subsequent chemical exposures may reflect alterations in gene expression due to exposures much earlier in life.
The new science is shaking up the classic, “nature versus nurture” model of genetics. “Yes, it does matter what you get from your parents, but … nutrition, stress and environmental factors are what control gene expression,” Dr. Myers told the AHMA. The conventional view holds that a genetic disease is under hereditary control, and largely inevitable. The emerging paradigm holds that many “genetic” diseases are linked to genes vulnerable to environmental influences.
Xenoestrogens & Obesity
A lot of toxins work by hijacking control of gene expression. This is well illustrated in a series of experiments with mice exposed to diethylstilbestrol (DES), a clearly estrogenic drug. Dr. Retha Newbold and colleagues at the Laboratory of Molecular Toxicology, National Institute of Environmental Health Sciences exposed pregnant white mice to IV doses of DES at several different concentrations, and studied the effects on the offspring.
Compared with non-exposed mice of the same strain, getting the same diet and same overall daily activity levels, those exposed to DES in utero showed marked differences in weight, and the differences were dose-specific. Mice whose mothers received the drug at 1 part per billion, gained weight to the point where they were clearly obese compared with non-exposed animals. Those exposed to 100 ppb levels lost weight, and had lower body mass than non-exposed mice.
In other words, fetal exposure to a xenoestrogen affected adult metabolism, and the direction of the effect was determined by the dose. The same genes, exposed to different levels of an estrogenic compound gave different metabolic outcomes.
Several prominent toxicological researchers, including Dr. Newbold, believe estrogenic environmental toxins play as much of a role in the global obesity epidemic as poor diet, lack of exercise and chronic stress. These toxins may also play a role in the etiology of type 2 diabetes. (Read Is Diabetes an Environmental Illness? Click here.)
The most ardent advocate of this idea is Paula Baillie-Hamilton, MD, PhD, a British researcher and author of The Detox Diet: Eliminate Chemical Calories and Restore Your Body’s Natural Slimming System. She argues, convincingly, that increased obesity worldwide tracks very closely with increases in synthetic chemical production, both curves rising since World War II, and accelerating quickly in the 1980s and 1990s (Baillie-Hamilton, P. J Altern Compl Med. 2002; 8(2): 185–192).
Again, it is difficult to prove direct causation from epidemiological correlations. But it is hard to ignore the fact that there are a host of estrogenic and hormonally-active synthetic compounds in our environment.
Phthalates in plastic, bisphenol A in linings of food containers, certain dental sealants, non-ionic surfactants in detergents, drugs, dietary supplements and personal care products containing hormones, growth-stimulating hormones in animal feeds, endocrine-disruptive pesticides, polybrominated biphenyls in fire retardants and polychlorinated biphenyls from polyvinyl chloride incineration are all estrogenic or hormonally active. It is certainly plausible that they would have metabolic effects, especially in aggregate.
Bisphenol A in the Crosshairs
Scientific and policy debate about endocrine-disrupting toxins is coming to a head around Bisphenol A (BPA), a ubiquitous component in many types of polycarbonate plastic. BPA is in water bottles and the plastic linings of cans and food containers. It is just about everywhere in modern plasto-centric living. It is also the poster chemical for Low Dose Environmental Toxins, said Dr. Myers.
As early as 1936, biochemists recognized that BPA was estrogenic, but it seemed very weak compared to physiologic estrogen or estrogenic drugs like DES. After WWII, and the plastics revolution, BPA entered the environment unfettered. And it has a knack for finding its way into human tissues. “If you measure anyone in this room,” Dr. Myers told conference participants, “you will find BPA at 2–12 ppb in their serum.”
The problem is that while 99% of all circulating physiologic estradiol is bound by serum binding proteins, none of the BPA is bound. “It’s all active, and it is all able to influence tissue function and fetal development.”
BPA can be physiologically active at levels of 1 ppb, which sounds negligible. But consider that a drop of water containing 1 ppb BPA actually contains 132 billion BPA molecules. Many hormones can influence tissue behavior and gene expression at such small concentrations. Just by way of comparison, Cialis, the erection drug has a target serum dose of 35 ppb. In most men this causes erections, and any higher, it causes priapism.
Look at cell membrane estrogen receptors, not nuclear estrogen receptors, and you see a lot more BPA binding, said Dr. Myers. If it binds, you get calcium/potassium exchange, which turns on the gene transcription cascade. BPA does this at 1 ppb levels, and it can affect over 200 different genes.
Animal studies of BPA show that it can cause androgen hypersensitization, leading to prostate gland enlargement and prostate cancer at levels of 10 ppb. There are more than 150 articles indicating that it can cause aneuploidy, leading to birth defects and miscarriage in animals.
There are only two published human epidemiological studies, both from Japan. One showed no health impact. The other, which compared women who’d had three or more miscarriages with women who’d never miscarried, showed three-fold higher levels of BPA in the susceptible women, and signs of aneuploidy in fetal tissue obtained from their babies (Sugiura-Ogasawara M, et al. Hum Reprod. 2006; 21(2): 565–566).
How Much is Too Much?
Current EPA standards deem BPA “safe” at levels of 50 mcg/kg/day or less. As of a year ago, there were 180 animal studies testing this compound at or below that allegedly safe level. Of the 167 studies funded by government agencies, 153 found biological effects suggestive of harm, while only 14 studies showed no effect. In contrast, all 13 studies funded by industry showed no effect. Coincidence? Dr. Myers doesn’t think so.
There is a movement afoot to ban BPA in plastics productions, but as is often the case with such efforts, it is getting bogged down in the burden-of-proof quagmire. “Regulators say the risk is still debatable,” said Dr. Myers, who strongly believes BPA is harmful and should be limited if not banned outright.
In August, an expert panel convened by the National Institutes of Health reported to the US National Toxicology Program that while the compound is an estrogen mimic and might possibly have detrimental effects on neurobehavioral development in babies and small children, it’s overall impact on public health is minimal.
One week earlier, though, a consortium of 38 independent international environmental health scientists issued a consensus statement that the substance is dangerous, citing a host of BPA-associated reproductive, neurobehavioral, and neoplastic health risks. Critics of the NIH panel say members are biased toward the chemical and plastics industries that would face a big and costly challenge to find BPA replacements should the government take regulatory action.
As with many specific ecological issues, organized medicine has been mum on BPA, and this is the very problem that frustrates eco-activists like Dr. Lerner and Mr. Ausubel. In the absence of a firm medical voice from informed physicians truly concerned about the health of their patients, efforts like the one to limit BPA fall victim to scientific hair-splitting, partisan politics, and industrial self-interest.
Restoring Balance: The Great Work
Dr. Myers and other environmental health leaders believe it is foolish to wait around for definitive proofs that will likely never emerge. “Many scientific questions still need to be answered, but we know enough now to start incorporating this scientific revolution into a new generation of precautionary health standards.”
Commonweal’s Dr. Lerner believes our current environmental crisis represents, “a fundamental failure of a holistic public health vision. We have failed to look at it, evaluate it, communicate it to our patients, and stand up and say, ‘This is the Great Work of our time: to restore balance.”
He called on physicians to take the lead on environmental health science. “Learn environmental science as part of what it means to be a holistic doctor. Be part of the small platoons in which the Great Virtues are practiced. Take local actions to ban pesticides, support organics, improve school food, phase out mercury use.”
Scott Shannon, MD, a holistic child psychiatrist and former president of the AHMA strongly agreed. “‘Ecology has to become personal. We really need to get out there and be engaged. We can’t just sit at home and be quiet about this.”
While much of the news these days is dire, Dr. Lerner remains optimistic. “Can we win? Yes, of course we can. We have a democracy, and we ended the colonial system. We won the civil rights movement. We won women’s rights. And the ecological and holistic movements are part of this long legacy of struggles that lead to victory, to major changes.”
To Bioneers’ Mr. Ausubel, the environmental health crisis is, at its root, a crisis of consciousness, a loss of recognition of the inter-relationship of all things.
“We think of ourselves as separate from nature. We are deeply out of relationship with nature and with the Earth and with each other. We need community, friendship, family, free time and real contact. We must recreate community. We need to recreate our inner relationship with ourselves. This is not about treating diseases. It is about engendering health and vitality.”
Resources
Bioneers (www.bioneers.org): A forum on environmental, health, social justice, and energy policy with a focus on problem-solving based on the design principle found in nature. Bioneers hosts a major annual conference and local satellite meetings.
Seeds of Change (www.seedsofchange.com): Dedicated to preserving biodiversity and promoting organic agriculture.
Commonweal (www.commonweal.org): Environmental health research institute and retreat center with special focus on helping people with cancer.
Health Care Without Harm (www.hcwh.org): Global organization of hospitals, clinics and individual practitioners dedicated to environmentally responsible health care and practical problem-solving.
Hospitals for a Healthy Environment (www.h2eonline.org): National organization for environmental sustainability in health care, with special focus and a wealth of resources for hospitals and large clinics trying to “green” their operations.
Collaborative on Health and the Environment (www.healthandenvironment.org): Partnership of individuals and organizations to advance knowledge of environmental factors in health and illness and foster interdisciplinary scientific collaborations.
Teleosis Institute (www.teleosis.org): Dedicated to sustainable, affordable health care, providing practical tools tailored to the needs of individual practitioners and small clinics.
Environmental Health Sciences (www.EnvironmentalHealthNews.org): Pete Myers’ informational website and email news service, featuring in-depth environmental health science and policy analysis.
Center on Environmental Oncology (www.environmentaloncology.org): University of Pittsburgh’s institute for research and policy on environmental influences on cancer, with special focus on cancers in women and minority populations.
Green Machine Shop (www.greenmachineshop.com): Company that builds eco-friendly computers and provides a wealth of information on the health impact of EMF, plastics, heavy metals and other tech-related risk factors.
Institute for Responsible Technology (www.responsibletechnology.org): Focused specifically on impact of agricultural practices, including use of genetically modified crops, on human and environmental health.
Naturally Occurring Standards Group (www.nosg.org): International consortium working to develop and harmonize meaningful and enforceable standards for safe, healthful organic agriculture and natural product production.
Avoiding Bisphenol A
It will likely be a long time before there is any substantial federal regulation limiting bisphenol A, an estrogenic component of many types of plastic.
While scientists argue back and forth about the extent to which this compound promotes cancer, neurobehavioral disorders or reproductive problems, people who are at high risk for any of these would be wise to reduce their exposure to BPA as much as possible, John Peterson “Pete” Myers, told attendees at the annual meeting of the American Holistic Medical Association.
That’s not so easy to do. The hormone-mimicking compound is used in the manufacture of polycarbonate plastics used as food and drink containers, can liners, and many other common household plastic items. BPA from the containers can easily leach into the contents they hold, especially when heated.
To reduce exposure, minimize the use of hard plastic water bottles (i.e. Nalgene bottles), storage containers, “sippy cups” and hard plastic baby bottles. It is a good idea to also minimize consumption of canned goods since most cans are lined with BPA-containing polycarbonate plastic. Acidic foods or beverages promote BPA leaching.
Glass is obviously, the preferred alternative, though it may not always be practical. Polyethylene and polypropylene are better plastics. They are identifiable as “No. 2” and “No. 5” plastics, indicated by the numbered triangular symbol typically pressed into most plastic containers. Polycarbonate plastics do not have a specific designation, but they usually fall into the “No. 7” miscellaneous plastics class.
A number of companies are now promoting BPA-free plastic items. Born Free (www.newbornfree.com), a Florida-based company, introduced a line of BPA-free and phthalate-free baby bottles, trainer cups, and related baby items. Natural food giant, Eden Foods (www.edenfoods.com), has introduced BPA-free cans for many of its less acidic canned vegetable products. With increased public outcry, other companies will likely follow suit, even though the BPA-free containers cost more.
For an excellent review on BPA and how to avoid it, check US News & World Report‘s August 2007 article, How to Avoid a Controversial Plastics Chemical (www.usnews.com).
Other online articles:
Roots of Health Begin in the Soil
Is Diabetes an Environmental Illness?
Endocrine Disruptors, Precocious Puberty & Reproductive System Cancer
