Congress: Protect Public Health, Not Toxic Chemicals
Americans have long been unwitting subjects in an uncontrolled experiment.
For decades, U.S. manufacturers—with the federal government's blessing—have been producing tens of thousands of untested, potentially toxic chemicals, many of which wind up in our bodies. These substances include suspected neurotoxins, carcinogens and endocrine disruptors, and thousands of other chemicals for which there is little or no information.
Photo courtesy of Shutterstock
Why? When Congress passed the landmark Toxic Substances Control Act (TSCA) nearly 40 years ago, the law considered chemicals already on the market to be safe. So while it required the government to review new chemicals for their toxicity, it exempted nearly 62,000 pre-existing, commercially available ones. They included such nasty substances as bisphenol A (BPA), ethyl benzene and toluene, and others that health officials still know very little about, including the relatively obscure 4-methylcyclohexane methanol (MCHM). That's the chemical that leaked into the Elk River in West Virginia earlier this year, contaminating the water supply of 300,000 area residents.
Only about 200 of the chemicals that were on the market before TSCA was enacted in 1977 have been tested for safety. Since then, the number of chemicals in the marketplace has jumped to more than 80,000, and TSCA's requirements for those new chemicals have hardly been stringent. Manufacturers are supposed to supply the U.S. Environmental Protection Agency (EPA) with information about production volume, intended uses and toxicity 90 days before they begin commercial-scale production. But 85 percent of the manufacturers' notifications have contained no health data, according to the EPA's own figures.
The result of this experiment?
On March 12, Dr. Philip Landrigan, a renowned pediatrician and epidemiologist, addressed this question as it pertains to children in testimony before the House Subcommittee on the Environment and the Economy. Landrigan is the dean for global health at the Mount Sinai Hospital medical school in Manhattan and co-author of a recent study on the "silent pandemic" of toxins damaging the brains of unborn children.
"Rates of a whole series of chronic diseases are on the rise in American children," Landrigan said. "Asthma has tripled. Childhood cancer incidence has gone up by 40 percent over the past 40 years. Autism now affects one child in 88. Attention Deficit Hyperactivity Disorder affects about one child in seven, according to data from the CDC [Centers for Disease Control and Prevention]. These chronic diseases of children are highly prevalent in today's world. They are on the increase...."
And many have been linked to toxic chemicals.
"There is a strong body of scientific evidence that toxic chemicals have contributed to diseases in children," Landrigan continued. "Going back 100 years ago, lead was shown to cause mental deficiency, learning problems and loss of IQ. Seventy-five years ago, methylmercury. More recently, clinical and epidemiologic studies have linked organophosphate pesticides, arsenic, manganese, brominated flame retardants, phthalates and bisphenol A to learning disabilities, loss of IQ, and problems of behavior in children."
Weakening TSCA Under the Guise of Reform
While the recent MCHM spill in West Virginia heightened public awareness about the threat posed by unregulated chemicals, Washington has been wrestling with updating TSCA for a number of years. Lisa Jackson, the EPA administrator during the first Obama Administration, stepped into the fray in 2012, proposing a half-dozen common-sense principles to strengthen public health protections. She pointed out that it is imperative that chemical manufacturers provide the EPA the data it needs to make safety evaluations that take into account the most vulnerable Americans, especially children. The EPA should review the most dangerous existing and new chemicals first, she said, and the new law should encourage manufacturers to produce safer, more sustainable chemicals and products. Finally, she stressed that Congress must shift the burden of proof to industry. Right now, the EPA has to prove a chemical is unsafe to restrict its use or take it off the market. Manufacturers, she said, should have to prove their chemicals are safe.
Public health, labor and environmental groups have been calling for TCSA reform with the same principles in mind for quite some time. Their efforts, however, have been frustrated by the chemical industry, which wields considerable power on Capitol Hill. What's different now is chemical manufacturers and other, related industries are now taking a new tack to undermine efforts to strengthen the law. They are encouraging Congress to pass legislation that appears to protect public health, but in fact would not.
Last May, Sen. Lautenberg (D-NJ) and Sen. Vitter (R-LA) introduced the Chemical Safety Improvement Act. "Improvement" sounds like an improvement, right? As drafted, however, the bill would weaken TSCA. For example, if TSCA has one saving grace, it permits states to establish their own safeguards to protect their residents from toxic chemicals. Some states, notably California, are way ahead of the federal government. The bill would largely preempt stricter state protections.
Lautenberg died shortly after introducing the bill, and after a July hearing, the bill stalled. Meanwhile, just a few weeks ago, the House took up the issue. On Feb. 27, Rep. Shimkus (R-IL) introduced a draft of what he is calling the Chemicals in Commerce Act.
He should have called it the More Toxic Chemicals in Commerce Act.
"Throughout the draft, the bill gives greater weight to reducing the burdens on industry than to protecting the public and the environment," Andrew Rosenberg, director of the Center for Science and Democracy at the Union of Concerned Scientists, explained in a March 5 letter to House members. "When chemical interests may face additional requirements, the bill gives them so many ways to evade or challenge them, that it reduces the Environmental Protection Agency's already insufficient authority to regulate toxic chemicals."
Rosenberg's letter pointed out other glaring problems with Shimkus' draft, including the fact that while it acknowledges that certain populations—namely infants, children, pregnant women, the elderly and people who live near chemical plants—may be more vulnerable to chemical exposure, it doesn't require the EPA to do anything to protect them. In addition, Rosenberg said, the bill would allow Congress and the courts to ignore the recommendations of government and independent scientists.
Rep. Waxman (D-CA) was equally dismissive. "This draft would restrict existing testing authority so that EPA could only require testing in the limited set of circumstances," he said at the same March 12 House hearing where Landrigan testified. "On top of that, the Catch-22 of current law would remain. The agency would be required to identify risk before being authorized to test for risk. This is the roadblock that has stymied the agency for years."
Instead of taking its cues from the chemical industry, Congress could look across the Atlantic for a workable model. Nearly a decade ago, the European Union adopted the "precautionary principle" to protect its citizens from toxic chemicals. Authorities there will not allow a chemical on the market until its manufacturer demonstrates it is safe. Last year, the European Commission published a study that found that chemicals in Europe are "considerably safer" since the EU established its Registration, Evaluation, Authorization and Restriction of Chemicals regulation in 2007, and manufacturers there are finding safer substitutes for toxic chemicals.
Here in the U.S., conversely, our toxic chemical policy is best described ascaveat emptor—let the buyer beware—and it's making us sick.
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The patient in the case report (let's call him Tom) was 54 and in good health. For two days in May, he felt unwell and was too weak to get out of bed. When his family finally brought him to the hospital, doctors found that he had a fever and signs of a severe infection, or sepsis. He tested positive for SARS-CoV-2, the virus that causes COVID-19 infection. In addition to symptoms of COVID-19, he was also too weak to move his legs.
When a neurologist examined him, Tom was diagnosed with Guillain-Barre Syndrome, an autoimmune disease that causes abnormal sensation and weakness due to delays in sending signals through the nerves. Usually reversible, in severe cases it can cause prolonged paralysis involving breathing muscles, require ventilator support and sometimes leave permanent neurological deficits. Early recognition by expert neurologists is key to proper treatment.
We are neurologists specializing in intensive care and leading studies related to neurological complications from COVID-19. Given the occurrence of Guillain-Barre Syndrome in prior pandemics with other corona viruses like SARS and MERS, we are investigating a possible link between Guillain-Barre Syndrome and COVID-19 and tracking published reports to see if there is any link between Guillain-Barre Syndrome and COVID-19.
Some patients may not seek timely medical care for neurological symptoms like prolonged headache, vision loss and new muscle weakness due to fear of getting exposed to virus in the emergency setting. People need to know that medical facilities have taken full precautions to protect patients. Seeking timely medical evaluation for neurological symptoms can help treat many of these diseases.
What Is Guillain-Barre Syndrome?
Guillain-Barre syndrome occurs when the body's own immune system attacks and injures the nerves outside of the spinal cord or brain – the peripheral nervous system. Most commonly, the injury involves the protective sheath, or myelin, that wraps nerves and is essential to nerve function.
Without the myelin sheath, signals that go through a nerve are slowed or lost, which causes the nerve to malfunction.
To diagnose Guillain-Barre Syndrome, neurologists perform a detailed neurological exam. Due to the nerve injury, patients often may have loss of reflexes on examination. Doctors often need to perform a lumbar puncture, otherwise known as spinal tap, to sample spinal fluid and look for signs of inflammation and abnormal antibodies.
Studies have shown that giving patients an infusion of antibodies derived from donated blood or plasma exchange – a process that cleans patients' blood of harmful antibodies - can speed up recovery. A very small subset of patients may need these therapies long-term.
The majority of Guillain-Barre Syndrome patients improve within a few weeks and eventually can make a full recovery. However, some patients with Guillain-Barre Syndrome have lingering symptoms including weakness and abnormal sensations in arms and/or legs; rarely patients may be bedridden or disabled long-term.
Guillain-Barre Syndrome and Pandemics
As the COVID-19 pandemic sweeps across the globe, many neurologic specialists have been on the lookout for potentially serious nervous system complications such as Guillain-Barre Syndrome.
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Studies showed an increase in Guillain-Barre Syndrome cases following the 2009 H1N1 flu pandemic, suggesting a possible connection. The presumed cause for this link is that the body's own immune response to fight the infection turns on itself and attacks the peripheral nerves. This is called an "autoimmune" condition. When a pandemic affects as many people as our current COVID-19 crisis, even a rare complication can become a significant public health problem. That is especially true for one that causes neurological dysfunction where the recovery takes a long time and may be incomplete.
Though there is clear clinical suspicion that COVID-19 can lead to Guillain-Barre Syndrome, many important questions remain. What are the chances that someone gets Guillain-Barre Syndrome during or following a COVID-19 infection? Does Guillain-Barre Syndrome happen more often in those who have been infected with COVID-19 compared to other types of infections, such as the flu?
The only way to get answers is through a prospective study where doctors perform systematic surveillance and collect data on a large group of patients. There are ongoing large research consortia hard at work to figure out answers to these questions.
Understanding the Association Between COVID-19 and Guillain-Barre Syndrome
While large research studies are underway, overall it appears that Guillain-Barre Syndrome is a rare but serious phenomenon possibly linked to COVID-19. Given that more than 10.7 million cases have been reported for COVID-19, there have been 10 reported cases of COVID-19 patients with Guillain-Barre Syndrome so far – only two reported cases in the U.S., five in Italy, two cases in Iran and one from Wuhan, China.
It is certainly possible that there are other cases that have not been reported. The Global Consortium Study of Neurological Dysfunctions in COVID-19 is actively underway to find out how often neurological problems like Guillain-Barre Syndrome is seen in hospitalized COVID-19 patients. Also, just because Guillain-Barre Syndrome occurs in a patient diagnosed with COVID-19, that does not imply that it was caused by the virus; this still may be a coincident occurrence. More research is needed to understand how the two events are related.
Due to the pandemic and infection-containment considerations, diagnostic tests, such as a nerve conduction study that used to be routine for patients with suspected Guillain-Barre Syndrome, are more difficult to do. In both U.S. cases, the initial diagnosis and treatment were all based on clinical examination by a neurological experts rather than any tests. Both patients survived but with significant residual weakness at the time these case reports came out, but that is not uncommon for Guillain-Barre Syndrome patients. The road to recovery may sometimes be long, but many patients can make a full recovery with time.
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Sherry H-Y. Chou is an Associate Professor of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh.
Aarti Sarwal is an Associate Professor, Neurology, Wake Forest University.
Neha S. Dangayach is an Assistant Professor of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai.
Disclosure statement: Sherry H-Y. Chou receives funding from The University of Pittsburgh Clinical Translational Science Institute (CTSI), the National Institute of Health, and the University of Pittsburgh School of Medicine Dean's Faculty Advancement Award. Sherry H-Y. Chou is a member of Board of Directors for the Neurocritical Care Society. Neha S. Dangayach receives funding from the Bee Foundation, the Friedman Brain Institute, the Neurocritical Care Society, InCHIP-UConn Center for mHealth and Social Media Seed Grant. She is faculty for emcrit.org and for AiSinai. Aarti Sarwal does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
Reposted with permission from The Conversation.
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