environmental epidemiology of the great lakes basin
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Environmental Epidemiology of the Great Lakes Basin. Industrial Pollution and Human Health August 1999. Overview. 1. Pollutants 2. Local examples, reaction of public health officials 3. Medical literature: health effects 4. Economics and politics. 1968. - PowerPoint PPT PresentationTRANSCRIPT
1
Environmental Epidemiology of the Great Lakes Basin
Industrial Pollution and Human Health
August 1999
2
Overview
1. Pollutants2. Local examples, reaction of public health
officials
3. Medical literature: health effects4. Economics and politics
3
1968
• University of Waterloo• Dr.Bryce Kendrick, Professor of Botany• University of Toronto• Dr. Don Chant, Professor of Zoology
• Pollution Probe
4
1989
• Dr. Paul Connett, Professor of Chemistry St. Lawrence University, New York State
• dioxin chemist
• Work on Waste USA
5
500 articles on Environmental toxics , 1992 - 1998
• Canadian Medical Association Journal• JAMA• New England Journal of Medicine• British Medical Journal• The Lancet• (others)
6
500 Journal articles on Toxics1992 - 1998
0102030405060708090
100
1992 1993 1994 1995 1996 1997 1998Year
Number of articlesappearing 1992 -1998
7
Medline computer search:dioxins and human health
1995 -Dec 1998• 217 articles in many other journals: e.g.
• J. Epidemiology and Community Health• Early Human Development• Environmental Health Perspectives• Chemosphere• Am J of Epidemiology
8
Robert Fletcher, M.D.internist, clinical epidemiologist
• Prof, Harvard Medical School• Founding editor , Journal of General
Internal Medicine• Editor, Annals of Internal Medicine• author, Clinical Epidemiology
9
Robert Fletcher, II
• What is your greatest concern?
• “Destruction of the good earth by toxins or nuclear waste.” (or simply too many people)
The Lancet, Lifeline, Jan 2, l999
10
“Toxics”
I. Any industrial pollutants
II. Chlorinated Organic chemicals, COC’s
11
Environmental Epidemiology of the Great Lakes
Human Health Effects of Industrial Pollutants, Effluents and Toxics
November 1998 presentation, Oakville Ontario, to:
12
Canadian Association of Physicians for the Environment
C.A.P.E.
13
Health Canada, l997
“State of Knowledge Reporton Environmental Contaminants
and Human Healthin the
Great Lakes Basin”
• 300 pages
14
Arctic Pollution Issues
• Arctic Pollution Issues, A State of the Arctic Environment Report, Arctic Monitoring and Assessment Program, Oslo, l997
• Highlights of the Canadian Arctic Contaminants Assessment Report, a community reference manual, Northern Contaminants Program, Ottawa, l997
15
Where do contaminants goin North America?
• Great Lakes Basin• St. Lawrence River
• Rocky Mountains• Arctic
16
Cdn J of Public HealthSupplement, May/June l998
• What on Earth? A National Symposium on Environmental Contaminants and the Implications for Child Health (selected papers)
• Canadian Institute of Child Health
• May l997, Ottawa
17
What are the causes of illnesses?
1. Genes
2. Environmental factors
18
McGinnis & Foege, DHSSJAMA, Nov 10, l993
“Actual Causes of Death in U.S.”
2 components to the cause of illness:
1. Genes 2. Environmental factors
19
Genetic factors in illness
• Genetic resistance/susceptibility• some individuals more susceptible than
others• e. g. cancer: tumor suppressor genes cancer families
20
Environmental factors in illness(McGinnis, JAMA, 1993)
1. Smoking2. Animal fat3. Alcohol4.infectious disease
5. TOXICS exposure6. Automobiles7. Firearms8.drugs
21
Toxics exposure in theGreat Lakes Basin?
• How many people?
36 million
22
How many chemicals are in the Great Lakes?
800
sources: agricultural industrial municipal
23
How many chemicals
• 100,000• 3,000 in high volume use• 95% have incomplete health data• 43% have no health data (Bev Thorpe,1999)
• present in: dirty dozen: Epstein
24
What chemicals??What pollutants??
1. Organic chemicals:
a. non chlorinated:
methanol, ammoniatoluene, benzene, methyl ethyl ketone,
ethylene glycol
25
2. Chlorinated/brominated organic chemicals, COC’s
“Persistent toxic substances”“Persistent organic pollutants, POPs” e.g. pcb’s, dioxins, furans
26
Dioxins
27
Barry Commoner2nd Citizens Conference on Dioxin, St. Louis,
Missouri, July, l994
• “Dioxin and dioxin-like substances represent the most perilous chemical threat to the health and biological integrity of human beings and the environment.”
28
WHO Tolerable Daily IntakeDioxin, Sept l998
• 1990: 10 picogram/kg for 2378 tet dioxin• new epidemiologic data on effects on
nervous and endocrine systems• new TDI, tolerable daily intake• 1 to 4 pg/kg
Medical Post,Sept 22, l998
29
Source of Daily Intake
Food
90%
30
Dioxin intake: Breast feeding
“In the Great Lakes Basin exposure to TCDD during Breast feeding exceeds the established TDI for this contaminant.”
• Cdn J of Public Health, May/June l997,
from Haines et al, Environ Res, 1998
31
Canadian Breast milk survey
• Twenty five Years of Surveillance for Contaminants in Human Breast Milk
• A. G Craan, D. A. Haines, Great Lakes Health Effects Program, Health Canada,
• Archives of Environ Contam and Toxicology. 35, 702 - 710 (1998)
32
Misleading?
• “There are indications that dioxin and furan levels in breast milk are decreasing (see Table 4 of the Craan and Haines article.) Further monitoring over the next ten years will be needed to confirm this trend.”
• D. Haines, personal communication, January 29, 1999
33
Daily Intake of Dioxin/furan from Breast milk ( pg/kg bw/day)
0102030405060708090
100
1967 1970 1975 1982 1986 1992
Dioxins + Furans inTEQs
34
Concentrations of dioxins and furans in Canadian human milk
pg/Kg Whole milk
0100200300400500600700800900
1982 1986 1992
2,3,7,8 TCDDTEQ D + F
35
1992 estimated daily intake of dioxin from breast milk/formula
pg TEQ/Kg body wgt/day
0
10
20
30
40
50
60
1992 WHO TDI 1998
Breast milkformula
36
WHO TDI Dioxin 19981 - 4 (2.5) pg/kg body wgt/day
• 5 - 6 month Canadian infant taking in 750 ml milk daily:
• Breast milk: 25 times TDI
• formula: 5 times
37
Misleading?
• “Table 6-5 shows that the mean levels ofd total PCDDs/PCDFs in adipose tissue of Canadians are comparable to those reported for other countries.” Page 65,
• State of Knowledge Report on Environmental Contaminants and Human Health in the Great Lakes Basin , Health Canada, 1997
38
Table 6-5
• Ryan, 1985, Canadian samples collected in 1976 throughout Canada , post mortem. U.S. samples collected l983-84,NY state
• Schecter, 1986, Vietnam. Southern areas were sprayed with Agent Orange while northern areas were not.
• 1029, 985, 1577, 147 respectively. (see also Sweden, Japan, East Germany,
39
Mean levels of PCDDs and PCDFs in Human Adipose Tissue
0200400600800
1000120014001600
Swed
en
Can
ada
Japa
n
Sout
hV
ietn
am
Total PCDDsTotal PCDFs
40
countries
• Sweden, 1986, Dsgren (some exposed)• New York State, USA , Ryan, 1983 (MVA)• Canada, Ryan, 1976, &Teschke, 1992 ( “ )• Japan, 1986, Ono• North Vietnam, Schecter, 1986 (no AO)• South Vietnam, “ (Agent Orange)• Fed Rep Germany, Rappe, 1987 (exposed)
41
“comparable”
• Levels in Canadians/ NY State residents sampled from accidental death (“unexposed”) victims
• comparable to:• countries where residents were exposed to
dioxins
42
What pollutants? II
2. Heavy Metals:
Mercury, lead, arsenic, cadmiumCopper, zinc
(No discussion of health effects)
43
What pollutants? III
3. Classic Air Pollutants
• Particulates (PM 10, PM 50)• Ozone• Acid Gases (Sox, Nox, HCl)• CO
44
What pollutants? IV
4. CO2
Global Warming
45
Sources• Industrial processes,
e.g. petrochemical industry e.g. PVC• coal fired power plants• automobile engines, (gas, diesel)• pulp and paper industry• waste incineration (3)• cement kilns• hazardous waste landfilling, dumping
46
Municipal Solid Waste: backyard barrel burning
• PVC plastic• significant source of dioxin
47
Incineration of Medical Waste, I
• U. S. E. P. A. • 3rd largest source of Dioxin
• major source of Mercury
• North American environment
48
Incineration of hospital/medical waste, II
• Lynn R. Goldman, MD, JAMA, Aug 12,98• EPA: assistant administrator for toxic
substances
• 2% of hospital waste needs incineration
• 75% -100% actual
49
What is the Current toxic load entering the Great Lakes Basin?
• Canadian NPRI, (1993)• U. S. EPA TRI , (l990)
• 1000 tonnes per week
• US GAO: 5% of total:• 20,000 tonnes per week
50
What is the Current toxic load entering the Great Lakes Basin?
Great Lakes United, 1997
2500 tonnes per week
(100 truck loads)
51
Provincial Auditor of Ontario1996
• 1200 tonnes in Province of Ontario /week
(1000 tonnes into the air)
52
NAFTA: CECToxic Load in North America
1998
• 1 million tonnes per year
53
54
What are (or could be) the Human Health Effects
of Toxics?
1. Proven2. Speculative/unproven
55
Public health Officials
Concerned citizensask questions
about hazardous chemicals in their communities
56
Public health officials offerReassurance
The following are some local, provincial, national and international
examples
57
Bay of Quinte Hazardous Waste Sites
1. Trenton Norampac: Dombind2. Aikens Road landfill3. Zwick’s Island Park landfill4. Meyer’s Pier coal gasification site, pah’s5. Bakelite plant, phenols6. Deloro mines: arsenic/radioactivity7. Rednersville Road , TCE8. Richmond municipal landfill site, Napanee
58
Other Hazardous Waste Sites
• West Lincoln, Ontario (incinerator)
• East Liverpool, Ohio ( “ )
• Times Beach, Missouri (dioxin in waste oil dust suppressant)
• Sydney Mines, Cape Breton Island (PAH’s)
59
#1
Rednersville, Ontario
60
Rednersville, Ontario, 1990
• Illegal hazardous waste site• 200 barrels of VOC’s: TCE, benzene• 1973-1988: 15 years• 16 (25) families: contaminated water• compare Woburn, Mass case
• MoH Health Study
61
Woburn, Massachusetts1970 - 1990
• Drinking water contamination with TCE• 2 local plants: W.R.Grace, Beatrice Foods• 12 children died of leukemia (‘70’s)• civil action by citizens, • EPA action, 1990• $70,000,000 liability, cleanup operation• Civil Action, Jonathan Harr,
62
Rednersville Health Study, 1990
• “no evidence of human health effects”.
63
#2
Zwick’s Island landfill, Meier’s PierBelleville, Ontario
64
Zwick’s Island Park, Meyers PierBelleville, l998
• Municipal/hazardous waste landfill• Creasy engineering Report• leaking : PAH’s (benzo (a) pyrene), VOC’s (chloroform)• compare NY State and Eurohazcon studies
• Municipal Health study: risk assessment shows elevated cancer risk at Meier’s Pier
65
• NY State ATSDR June l998: cancer
• Eurohazcon study, Dolk,1998: congenital
defects (The Lancet)
66
Zwick’s Island/Meyer’s Pier Creasy (Engineering), 1998
• Belleville City Council says reports show the following compounds in the landfill sites:
• sodium chloride, “table salt” (Belleville Intelligencer)
• “ammonia” (smelling salts) (Community Press, Dec.24, 98)
67
Zwick’s Island/Meyer’s Pier Health Study, 1998
“These places are not unsafe for people.”
City Administrator, Belleville Intelligencer, Nov.3,98
68
#3
Dombind, Eastern Ontario
69
Dombind, 1993 - 98 Hastings/Northumberland/Peterborough
Trent River-Moira watershed
• Dust suppressant in 90 townships• Domtar spent black liquor• 50 million litres/yr (6100 tanker trucks)• Dioxins, furans, metals, phenols• compare Times Beach, Missouri
• MoH Health Study (Hukowich):
70
1994, Times Beach, Missouri
• 2nd Citizen’s Conference on Dioxin
• St. Louis/Times Beach• 1970’s• dioxin-contaminated waste oil as dust suppressant on roads
71
Dombind Health Study, 1998
• “On the very narrow issue of whether the use of Dombind constitutes a health hazard within the Health Protection and Promotion Act, I have concluded that it does not.”
Alex Hukowich, MOH, Peterborough
Belleville Intelligencer, Oct 21, l998
72
Norampac Inc, Trenton
• Dombind disposal problem• consideration underway (1999) for
hazardous waste incinerator construction as an alternative to Dombind method of disposal of pulp liquor
73
#4
Richmond landfill site, Napanee, Ont
74
Richmond (Napanee) landfill site
• 2 million tonnes existing• Canadian Waste Services• application for 750,000 more annual tonnes• leachate flow into:Marysville,Sucker Creek• thence into Bay of Quinte• Committee of Concerned Residents• Paul Finkle, Stephen Geneja, Residents• community press, April 2, 1999
75
#5
Kingston landfill site
76
Kingston landfill case, 1999
• Janet Fletcher• private prosecution, federal Fisheries Act• joined eventually by MoE who initially
declined the opportunity• guilty• fine• see 1999 press file
77
#6
Arsenic leakage into Moira River Deloro, Ontario
78
Deloro, Ontario
• Arsenic leakage into river at Deloro • 100,000 tonnes of arsenic tailings• 10 tonnes per yr leak into Moira R• Deloro human health Risk study,1999: no
human health effects• Moira River Impact study, 1999, screening
human health risk assessment under way
79
Deloro hazardous waste site
• Spring, 1999 MoE health study• urine samples• control urines: ?neighbouring community• number of people: ?200• MoE toxicologist:• likelihood of stat sign findings: low• “crackerjack teams of experts in Toronto”
80
#7
Peterborough,Ontario
81
Peterborough, Ontario
• Feasibility hearings for municipal incinerator construction, April 1999
82
#8
Cornwall, OntarioMaterial resources recovery unit
83
Cornwall, Ontariomaterial resources recovery unit
• Public hearings, attended by Ellen and Paul Connett, August 1999
• application for permit to burn 30,000 ppm PCB’s, current permitted for 50 ppm
• Cornwall/Massena area already heavily contaminated with PCB’s
84
Cornwall hazardous waste incinerator
• October 1998, began operation• PCB’s from fluorescent light ballast• In the new permit they also want to burn:• pharmaceuticals, chloroflurocarbons,
electrical equipment, poisonous and reactive gasses, “controlled substances” and waste oils.
85
Response of Medical Officer of Health
• Dr. Bourdeau: 5 county Eastern Ontario Health Unit, quoted the: 1996 Harvard Report on Cancer Prevention (R. Clapp) to explain cancers:
• 30% from smoking, 30% from obesity and fat and lack of exercise
• and 2% from environmental sources.• (noted lower male:female birth ratio in Cornwall
in passing)
86
#9
West Lincoln, Ontario failed proposal of 1980’s
87
OWMC hazardous waste facilityWest Lincoln, Ontario, 1980’s
• Hazardous waste incinerator• 60,000 tonnes per year • Joint Board Hearings, Oakville Ontario• 1991 - 1993
• Health Risk Assessment
88
West Lincoln Risk Assessment
• Negligible Cancer risks• No Non Cancer health effects
• “No evidence of significant health effects”
89
Examples from elsewhere in Canada and United States
90
# 1
Sydney Tar Ponds, Nova Scotia
91
Sydney Mines, Cape Breton, NSTar ponds, 1995
• CMAJ, March l5, l995• cokes ovens, steel plants• PAH’s in tar ponds (700,000 tonnes
sediment)• Cancer mortality: 25% higher in women, 49% higher in
men than provincial average
• Provincial Epidemiologist:
92
Sydney tar ponds
• Lifestyle factors, namely smoking and poor diet, were said to be responsible by public health officials
93
#2
East Liverpool, Ohiohazardous waste incinerator
94
WTI hazardous waste incineratorEast Liverpool, Ohio, 1997
• Hazardous waste incinerator• 200 miles south of Oakville• 60,000 to 170,000 tonnes per year• EPA hearings, East Liverpool, 1997• Dioxin output ?????? (UNKNOWN)
• Health Risk Assessment, 3500 pages
95
East Liverpool Risk Assessment
• Negligible Cancer risk• No additional Non Cancer health effects
• “No evidence of significant health effects”
96
Citizens ask questions about toxic substances in their
communities
• Public health officials
• 1. Epidemiology 2. Risk Assessment
97
“No evidence of human health risk.”
98
Hamilton, March 1999EverydayCarcinogens conference
• Dr. Richard Schabas• head, cancer prevention, CCO• keynote speaker• did not address the issue of environmental
carcinogens
• citizen delegation to CCO, July 1999, presentation made to Dr. Ken Shumak
99
Reassurance
Pattern of Denial ?
by public health authorities
100
Denial by developers
• Royal Group Technologies, Woodbridge• “plastic houses”• PVC interlocking panels for wall
construction• filled with cement• since 1996
101
Denial by developers, II
• Charlie Cray, Greenpeace, Chicago
• “PVC emits dioxin when it burns. It’s very toxic”
102
Denial by developers, III
• Gwain Cornish, senior VP and chemist• Royal Group Technologies• “The amount of dioxin emitted by burning
PVC is negligible. Even mashed potatoes give off more toxins than PVC.”
Globe and Mail, Jan 23, l999
103
Medical literature
1992 - 1998
104
Non reassuringmedical literature
1. Limitations of Epidemiology and Risk Assessment
2. Reports: changes in disease patterns strong hints: industrial chemicals are implicated
105
“More controversy, little clarification”…
• “The impact of low-level exposures on human health has proved difficult to investigate but refined environmental epidemiological methods and mechanistic studies are providing new insights…..Although environmental health risks are of low magnitude and difficult to prove, they may still pose …..
106
……….The LancetEnd of Year Review, Dec 1998
….an important public health problem if large numbers of people are exposed, and if certain populations are disproportionately exposed…..The need for better risk assessment and better education of the public regarding environmental risks is being recognized.”
Carrie Redlich, MD, Yale University
107
I. Cancer
108
Dr. Bernard Dixon, editor BMJ, June 11, l995
“Cancer is essentially a disease of genes which are triggered into mischief by external carcinogens such as chemicals and radiation.”
109
Epidemiology(has a problem)
Do industrial effluents
cause cancer?
110
Dr. Anthony Miller,U of T Epidemiology
JAMA Feb 9, l994
• “We must remember the long natural history of cancer, and that the full effect of exposures to carcinogens in early life may not be seen until those exposed reach advanced age.”
111
Dr. David KesslerU. S. FDA,
Joint Report of Pesticide Use, June l993
• “We know that children are overexposed, and we know that the chemicals are toxic. But when cancer or chronic neurological, immune or reproductive problems show up years later there will be no footprints left.”
112
CLASSIFICATION OF CANCERby Age
1. Childhood Cancer, < age l7, 19
2. Adult cancer
113
Childhood Cancer
• Dr. Anthony Miller • CMAJ Dec l5, l994• 1969 - 1988 • overall incidence: rose from 13 to 17 per
100,000
• 20% increase in 20 years
114
Canadian Childhood Cancer Control Program , I
Gibbons, Mao, Levy, Miller, CMAJ, Dec l5, l994
02468
1012141618
1969 1972 1975 1978 1981 1984 1987
No. of cases of cancerper 100,000 children,1969 - 1988
115
Canadian Childhood Cancer Control Program II,
Gibbons, Mao, Levy, Miller, CMAJ, Dec l5, l994
00.5
11.5
22.5
33.5
44.5
5
1969 1972 1975 1978 1981 1984 1987
No of cases ofchildhood leukemiaper 100,000, 1969 -1988
116
Childhood ALL
• Landrigan and Pui• NEJM Nov 9, l995• SEER data• from l973 to l991• increased from 2.7 to 3.3 cases per 100,000
children
• 20% increase in 20 years• causes: unknown, ? Environmental toxins
117
Childhood Brain Tumors
• Dr. Rutka, Neurosurgeon, HSC• Medical Post, September l5, l998• 1990: 60 • 1997: 100• Dr. John McLaughlan,U of T Epidemiology• “There is strong evidence that children who live in close
proximity to hydro transformers, nuclear power plants and industrial toxins are at greater risk of brain tumors.”
118
Parliamentary Assistant to the federal Minister of the Environment
• Paddy Torsney• AAUW/CFWW Cross Border Conference• October l998• male: “25% increase”• female: “42% increase”
in rates of Childhood Cancer• ? Reference/source
119
“Childhood Cancer and Environmental Contaminants”
• Cdn J Public Health, June 1998• Mary Mcbride, B.C. Cancer Control
Agency
• 185 references
120
Adult Cancer
121
Adult Cancers
• Common, increasing: lung, (bowel), breast, prostate.
• Uncommon, increasing: 1. NHL 2. Brain tumors 3. Melanoma 4. Testicular cancer
122
Common Cancers
123
Lung Cancer
Genes
124
Tumor suppressor genes
• Control cell reproduction
• Individuals/families who are:
genetically RESISTANT “ SUSCEPTIBLE to cancer
125
Tumour suppressor genes:Normal vs. Mutations
0%10%20%30%40%50%60%70%80%90%
100%
resistant TO CANCER susceptible
MutantNormal
126
Lung Cancer
• Tang, (Smithville, USA)• Lancet Oct 26, l996• 4000 chemicals in Cigarette smoke• Benzo (a) pyrene
• DNA damage to p53 tumor suppressor gene
127
Tang
(one) mechanismby which
Toxics cause cancer
128
Benzo (a) pyrenein the Great Lakes Basin
• PAH (polyaromatic hydrocarbon)• by product of petrochemical processes
• IJC, International Joint Commission• 11 critical contaminants: pcb, dioxin, furan,
ddt, toxaphene, mirex, dieldrin, hcb, methyl mercury, alkylated lead, benzo(a)pyrene
129
Bowel cancer:Chlorine and drinking water (I)
• Will King, OCTRF/Queen’s University• Dec 6 , l995• chlorinated water• 10% increase in bowel (and bladder)
cancer• ?Trihalomethanes
130
Bowel cancer:chlorinated drinking water (II)
• Doyle, Univ of Minnesota• Lancet, Aug 23, l997• 28,000 post menopausal women in Iowa• chlorinated drinking water• increased colon cancer
131
Breast Cancer & industrial chemicals
• Dr. Devra Davis• World Resources Institute• JAMA, Feb 9, l994• 1973 - 1987• 19 % increase
• ? Environmental xenoestrogens
132
CCO graphBreast cancer incidence
• Rising• on display at Everyday Carcinogens conf• March 1999
133
Devra Davis: (cont’d)
• “There are critical periods in development, e.g. the first trimester of pregnancy and adolescence, when sensitivity to carcinogenesis is high. Timing of exposure to chemicals and radiation can be more important than dose.”
134
Breast cancer and chemicals:CON
• Stephen Safe, Ph.D, Texas A&M University• editorial, NEJM, Oct 30, l997• “chemophobia, the unreasonable fear of
chemicals”• “paparazzi science”
• 2 problems ??
135
Safe’s editorial
• Hunter ? Doubtful conclusions
• ?undeclared interests (CMA)
136
Breast Cancer and chemicals: CON
• Hunter, Organochlorines and the risk of breast cancer, NEJM, Oct 30, l997
• 240 women, case control study• pcb, dde levels• No difference on organochlorine levels
• (? Breast cancer group genetically susceptible)
137
Breast cancer & Breast feeding• Moysich, Vena, SUNY Buffalo, l997• women from Love Canal area, western NY• organochlorine exposure• breast feeding was a protective factor vs
breast cancer: lower blood levels of DDE• “The chief mechanism for eliminating
organochlorides from the breast is lactation, which flushes them from the system.”
138
...Recipient of this toxic flush
…...Newborn breast feeding infant
139
Prostate Cancer
• Morrison, LCDC• Cdn Journal of Public Health, • July/Aug ‘96• predicted tripling in rates over next 20 yrs• “part of the increase may be due to
chemicals in the environment ” ????• no evidence
140
Prostate cancer, II
• Gallagher, Fleshner• CMAJ, October 6, l998• strong relationship to Dietary Fat intake
141
Uncommon Cancers(that are increasing)
* 1. NHL 2. Brain tumors 3. Melanoma * 4. Testicular cancer
142
Non Hodgkin’s Lymphomas, I
• Adami et al, Sweden• BMJ, June 10, l995
• 2 - 4% annual increase • in a number of countries• ?role of u/v exposure
143
Non-Hodgkin’s Lymphomas, II
• Freedman• BMJ May 17, l997• mortality NOT associated with u/v exposure• ? Unsuspected environmental agents
144
Non-Hodgkin’s Lymphomas, III
• Rothman, Cantor• Lancet, July 26, l997• occurrence of NHL related to PCB levels• ?immunosuppression, with EBV
susceptibility
145
Non Hodgkin’s Lymphomas
• 2 - 4 % annual increase
• Rothman, Cantor• Lancet, July 26, l997• occurrence of NHL related to PCB levels
146
Testicular cancer, I
• 2 - 4 % annual increase for last 25 years
• Scandinavia, Europe, North America• Danish EPA, l995• Canada, 2% annual increase ,
over 30 yrs,Weir, Jan 26,1999,CMAJ
147
Testicular cancer, II
• “It is a reasonable hypothesis that toxins acting during the early fetal development of the gonads are involved in the ….increase in the incidence of testicular germ cell cancer…..The likely culprits include DDT, PCBs, nonylphenol, bisphenols and vinclozolin.”
• L. Klotz, MD, CMAJ, Jan 26, 1999
148
Testicular cancer, III
• “Changes in male genitalia, such as the increasing incidence of testicular cancer in the U. S., could be like a canary in a mine shaft.”
• Harry Fisch, director, Male Reproductive Centre, Columbia Presbyterian Medical Centre, New York
Globe and Mail, Jan 26, l999
149
Adult Brain Cancer
• Workshop Group on Brain cancer• CMAJ, March l5, l992• DOUBLING of rate, 1969 - 1985• age > 65• occupational and non-occupational
exposure to chemicals
150
Melanoma
• BMJ Jan 20, l996• DOUBLING of rate in Southern
Hemisphere• chlorofluorocarbon release:• ozone loss, increased u/v exposure
151
II. Non Cancer illnesses
152
Non-cancer illnesses
• 1. CardioRespiratory• 2. Reproductive and Developmental• 3. Neuropsychological 4. Endocrine 5. Immunological
153
1. CardioRespiratory
• Asthma• Chronic lung disease• Myocardial infarction
• 1800 deaths annually in Ontario from cardio-respiratory disease related to air pollutants (Eva Ligeti, Ontario government Environment commissioner, 1998)
154
Classic Air Pollutants:
• Particulates (PM 10, PM 50)• Ozone• Acid Gases (Sox, Nox, HCl)• CO
155
2. Reproduction and
Development
156
Environmental Estrogens“Xenoestrogens”
1. Chlorinated organic chemicals
2. APE’s (alpha phenyl ethoxylates), surfactants, detergents
3. Bisphenols (polycarbonate subunit)
4. phthalates (plasticizers)
157
2.Reproduction & Development
a. (Canadian) MEN1. declining sperm counts2. declining male:female birth ratio3. Increasing abnormalities of male sex organs
(hypospadias)4. Shrinking testicle size(Klotz, CMAJ,Jan99)5. Increasing testicular cancer
158
Declining Sperm Counts, I
• Carlsen, Skakkebakk (Copenhagen)• BMJ, l992• metanalysis of 61 studies:• 50 years, 1940 - 1990• 40% reduction in sperm count• coincidental introduction of COC’s into
industrial production in 1940
159
Declining Sperm Counts, II
• French (Thibeault, Bujan• British (Irvine, Sharp)• American (Fisch)• Scandinavian (Pajarinen)
160
Declining Sperm Counts, III
• Canadian study: Feb l998• Health Canada/McMaster University• 49,000 Canadian men• 1984 - 1996, 11 centers
• 1.4 % reduction per year
161
Declining Sperm Counts, IV
• Swan (California)• Lancet Nov 29, l997• reanalysis of Carlsen’s meta analysis, l992
• USA: 1.5% reduction annually, 1938 - 90• Europe: 3.1% reduction annually,l971- 90
162
?Declining Sperm Counts
• NIH
• ACDCP
• started study Nov l997
163
Male genital malformations: Hypospadias
• Paulozzi, (Pediatrics, 100, l997)• Atlanta, l968 - 1992• DOUBLING to 30 per 10,000 births
• similar increases documented in:• US wide Birth defects monitoring program• European/Scandinavian studies of l980’s
164
Declining male:female birth ratio I
• Usual ratio: 51.5% are male 106: 100• declines documented in:
• Davis & Gottlieb, JAMA April 1, l998 (European countries)• Patterson, Lancet Aug 10, l996 (Seveso)• Williams, Int’ J Epidem, l992 (incinerators)
165
Declining male:female birth ratio II
• Allan, Jarrell et al• CMAJ Jan 1, l997• Canada, 1930 - 1990• after l970: 2.2 less male births/1000/year• ovulation inductions drugs could NOT
account for all of the reduction
166
2.Reproduction & Development
b. WOMEN
1. Shorter menstrual cycles2. Threatened miscarriage3. Endometriosis4. Premature ovarian failure
167
Delay in Conception?
• Mendola, Buck• Am J Epidemiology, Dec 2, l998• New York State residents• eating Lake Ontario fish for 7 yrs• No significant delay in conception • Menstrual cycle was 1.1 days shorter
168
Premature ovarian failure/menopause
• Cowan & Seifer• Clinical Reproductive Medicine, 1997• 7 causes of premature menopause• “environmental dioxin”
169
2.Reproduction & Development
c. EMBRYO, FETUS AND NEONATE:Birth cycle:
1. Ovary contamination2. IUGR3. Congenital birth defects4. Increased gonadal intersex 5. Breast milk contamination
170
Soderstrom, Michigan State Medical Society CMAJ, Oct 1, l998
• “The development of embryos of different species is a very similar thing, especially in the first few weeks. Whether it’s a human, a fish or a bird, it goes through much the same process. So if there’s an extensive problem for (wildlife such as) fish and birds, and there certainly has been, there is no reason to think that there cannot be effects on humans.”
171
Preconceptual environment
• Jarrell• CMAJ, April l5, l993• ? 6 Canadian cities• fluid in human ovarian follicles• measurable levels of 5 organochlorines:
dde, pcb, hexachlorobenzene, chlordane, heptachlor
172
Fetal development
• Vivyan Howard• University of Liverpool Fetal
toxicopathology group• 2nd Citizens Conference on Dioxin, l994• IUGR as a conseqence of toxics exposure
173
Congenital Birth Defects I
• Lie, NEJM July 7, l994: cause of 2/3 of birth defects is unknown
• Rodgers, University of Kentucky, 1994: increased birth defects in Times Beach, Missouri after dioxin contamination
• U. S. IOM, Lancet June 8, l996: Agent Orange (dioxin) and Spina Bifida in children of Vietnam veterans
174
Congenital Birth Defects II
• Helen Dolk, London School of Hygiene• Lancet, August 8, l998• Eurohazcon study (hazardous waste sites)• residents within 3 km of landfill• 1.33 Odds Ratio : congenital anomalies• NTD’s, cardiac septal defects, transposition of
great arteries and veins • statistically significant
175
Breast feeding, I
• Frank, Newman• CMAJ, July 1993• pcb’s and other toxics in breast milk• “good evidence of subtle fetal and infant
health effects resulting from prenatal (intrauterine) exposure”
176
Breast feeding, II
• WHO committee• Lancet, BMJ, May l997• 2 month old breast fed infant• receives 17 times the TDI of pcb’s and
dioxins from breast milk (50 times)• breast feeding a “significant risk” ??
177
Breast feeding, III
• Craan & Haines, GHEP, Canada• Arch Environ Contam Toxicol, l998. 35,
702-10• Twenty five years of Surveillance for
Contaminants in Human Breast Milk• Canada: 6 surveys of human breast milk .
1967, 1970, 1975, 1982, 1986, 1992
178
Canadian Breast milk studies
• Summary: Persistent Environmental Contaminants and the Great Lakes Basin Population: An Exposure Assessment
• Health Canada, 1998• Douglas Haines, GLHEP
179
Canadian Breast milk
A B C D E• 1982: 889 95• 1986: 562 60• 1992: 522 56 12 2.5 25/5• A . pg TEQ D+F/kg whole milk• B/C Pg Teq D+F/kg body wgt/day daily
intake, Breast milk/formula• C. WHO TDI, l998 D. factor over WHO
180
3. Brain
• PCB’s and brain injury in:• babies/children of fish-eating residents of: Lake Michigan (Jacobson) Lake Ontario (Daley)
• adults St. Lawrence River (Mergler)
181
Human brain development:Lancet Oct 11, l997
• 20th week of gestation . • number of new synapses (nerve cells and
connections) being formed per second:
40,000
• Can toxic exposures interfere?
182
Neuropsychological, I
• Jacobson & Jacobson• NEJM Sept 12, l996• followup of original cohort, now age 11• pcb’s in utero from contaminated Lake
Michigan fish eaten during pregnancy• abnormal body wgt/head circ at birth• 6 point IQ reduction at age 11
183
Neuropsychological II
• Helen Daly• SUNY Oswego NY• mothers ate pcb-contaminated Lake
Ontario fish during pregnancy• newborn babies• “abnormal psychological reactions”• (No abnormal body weights/head circ)
184
Neuropsychological , III
• Kosatsky, Mergler 1997• Gt. Lakes/St. Lawrence Health Conference• Lac St. Louis, Lac St. Francois• deficits in attention, concentration and
cognitive intellectual function in fish eaters• pcb levels in fish eaters were “well within
Health Canada guidelines”
185
4. Immunologic Effects
186
Immunologic Effects, I
• McConnachie, Illinois, 1994• 2nd Citizen’s Conference on Dioxin• Times Beach, Missouri, dioxin exposure• children• lymphocyte dysfunction
187
Immunologic Effects, II
• Repetto, World Resources Institute• JAMA March 27, l996• Pesticides and the Immune System• immune system dysfunction in children
188
5. Endocrine Effects
189
Endocrine Effects
• Koppe, Netherlands• Lancet Feb 3, l996• thyroid neonatal dysfunction after dioxin
exposure• structural similarilty between dioxin and
thyroxine molecules
190
Conclusions
Environmental Economics
191
Comparison: Intel Corporation(and the Silicon Chip)
• New York Times , December 3, l995• Semiconductor manufacturing plant• New Mexico• environment is “thousands of times cleaner
than an operating room”• Price: $ 1 Billion
192
Government of Ontario, I(and the human brain)
• Ministry of Environment Operating Budget• l993/94 $ 390 million• 1994/95, 95/96 240 “• 1996/97 150 “
193
Government of Ontario II(and the human brain)
0
50
100
150
200
250
300
350
400
1994 1995 1996 1997
Annual OperatingBudget, MoE, 1994 - l997
194
Government of Ontario , III
• 1995 - 1998: MoE:
• number of pollution investigators: fell 28%• total staffing: fell 32%
195
Government of Ontario, IV
• “We truly believe that this government has done more than any previous government to aid the environment. ”
Norman Sterling June 22, l998
Minister of Environment
196
Provincial Auditor of Ontario,1996
• 226 air-pollutant standards required reassessment (1992 MoE study)
• substantial reductions needed in releases of air pollutants:“aggressive 3 year MoE plan”
197
Provincial Auditor , 1998
• Erik Peters• followup November 4,1998
• “not a single one of the 226 air pollutant standards has been updated”
198
Minister of Environment, 1998
• Norman Sterling, Nov 4, l998
“When you are striking scientific-based standards, it does take a bit of time.”
199
Waste water standards, l996MoE enforcement
• 1000 violations• sewage, pulp & paper, mining,chemical, etc• 3 fines: Malette, Domtar, Russell• FoI Act: Sierra Legal Defense Fund• $20,000 charge levied• 1 1/2 year process• Privacy commissioner settled eventually
200
MoE, 1996, II
• Karen Vaux, spokeswoman:
• “Our priority is to get them to fix it and ensure that these type of occurrences don’t happen again.”
201
500 Journal articles on Toxics1992 - 1998
0102030405060708090
100
1992 1993 1994 1995 1996 1997 1998Year
Number of articlesappearing 1992 -1998
202
Government of Ontario II
0
50
100
150
200
250
300
350
400
1994 1995 1996 1997
Annual OperatingBudget, MoE, 1994 - l997
203
Linkage
• Government funding for environmental work
• environmental research
204
Montreal Biosphere1999
• Multimedia presentation: Mission Bios H20
• but: “in the last 15 years the situation has greatly improved”
• (How would you know?)
205
Dr. Pierre Belandformer commissioner, IJC
1998 GLU Citizen’s Hearings “Governments are becoming more and more
uninterested in the environment….. Knowledge of the health of the Beluga in
the St. Lawrence River is now uncertain. There is no 1998 data because there is no money to analyze and research.”
206
Eva LigetiEnvironmental commission, Ont
• State of Environment report 1998• released 1999• Ligeti met with new Minister of
Environment August 1999, Tony Clement who said he “could do business with her”
• Ligeti fired the next day by the government• Globe and Mail, week of August 16, 1999
207
International Joint Commissionof the Great Lakes, 9th Biennial Report
• “The evidence is overwhelming: certain persistent toxic substances impair human intellectual capacity, change behaviour, damage the immune system and compromise reproductive capacity. The people most at risk are children, pregnant women, women of child bearing age and people who rely on fish and wildlife…….
208
IJC, 9th Biennial Report, II
• …as a major part of their diet. Particularly at risk are developing embryos and nursing infants.”
July l998
209