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.
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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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By Ana Maldonado-Contreras
- Your gut is home to trillions of bacteria that are vital for keeping you healthy.
- Some of these microbes help to regulate the immune system.
- New research, which has not yet been peer-reviewed, shows the presence of certain bacteria in the gut may reveal which people are more vulnerable to a more severe case of COVID-19.
You may not know it, but you have an army of microbes living inside of you that are essential for fighting off threats, including the virus that causes COVID-19.
How Do Resident Bacteria Keep You Healthy?<p>Our immune defense is part of a complex biological response against harmful pathogens, such as viruses or bacteria. However, because our bodies are inhabited by trillions of mostly beneficial bacteria, virus and fungi, activation of our immune response is tightly regulated to distinguish between harmful and helpful microbes.</p><p>Our bacteria are spectacular companions diligently helping prime our immune system defenses to combat infections. A seminal study found that mice treated with antibiotics that eliminate bacteria in the gut exhibited an impaired immune response. These animals had low counts of virus-fighting white blood cells, weak antibody responses and poor production of a protein that is vital for <a href="https://doi.org/10.1073/pnas.1019378108" target="_blank">combating viral infection and modulating the immune response</a>.</p><p><a href="https://doi.org/10.1371/journal.pone.0184976" target="_blank" rel="noopener noreferrer">In another study</a>, mice were fed <em>Lactobacillus</em> bacteria, commonly used as probiotic in fermented food. These microbes reduced the severity of influenza infection. The <em>Lactobacillus</em>-treated mice did not lose weight and had only mild lung damage compared with untreated mice. Similarly, others have found that treatment of mice with <em>Lactobacillus</em> protects against different <a href="https://doi.org/10.1038/srep04638" target="_blank" rel="noopener noreferrer">subtypes of</a> <a href="https://doi.org/10.1038/s41598-017-17487-8" target="_blank" rel="noopener noreferrer">influenza</a> <a href="https://doi.org/10.1371/journal.ppat.1008072" target="_blank" rel="noopener noreferrer">virus</a> and human respiratory syncytial virus – the <a href="https://doi.org/10.1038/s41598-019-39602-7" target="_blank" rel="noopener noreferrer">major cause of viral bronchiolitis and pneumonia in children</a>.</p>
Chronic Disease and Microbes<p>Patients with chronic illnesses including Type 2 diabetes, obesity and cardiovascular disease exhibit a hyperactive immune system that fails to recognize a harmless stimulus and is linked to an altered gut microbiome.</p><p>In these chronic diseases, the gut microbiome lacks bacteria that activate <a href="https://doi.org/10.1126/science.1198469" target="_blank" rel="noopener noreferrer">immune cells</a> that block the response against harmless bacteria in our guts. Such alteration of the gut microbiome is also observed in <a href="https://doi.org/10.1073/pnas.1002601107" target="_blank" rel="noopener noreferrer">babies delivered by cesarean section</a>, individuals consuming a poor <a href="https://doi.org/10.1038/nature12820" target="_blank" rel="noopener noreferrer">diet</a> and the <a href="https://doi.org/10.1038/nature11053" target="_blank" rel="noopener noreferrer">elderly</a>.</p><p>In the U.S., 117 million individuals – about half the adult population – <a href="https://health.gov/our-work/food-nutrition/2015-2020-dietary-guidelines/guidelines/" target="_blank" rel="noopener noreferrer">suffer from Type 2 diabetes, obesity, cardiovascular disease or a combination of them</a>. That suggests that half of American adults carry a faulty microbiome army.</p><p>Research in my laboratory focuses on identifying gut bacteria that are critical for creating a balanced immune system, which fights life-threatening bacterial and viral infections, while tolerating the beneficial bacteria in and on us.</p><p>Given that diet affects the diversity of bacteria in the gut, <a href="https://www.umassmed.edu/nutrition/melody-trial-info/" target="_blank" rel="noopener noreferrer">my lab studies show how diet can be used</a> as a therapy for chronic diseases. Using different foods, people can shift their gut microbiome to one that boosts a healthy immune response.</p><p>A fraction of patients infected with SARS-CoV-2, the virus that causes COVID-19 disease, develop severe complications that require hospitalization in intensive care units. What do many of those patients have in common? <a href="https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm" target="_blank" rel="noopener noreferrer">Old age</a> and chronic diet-related diseases like obesity, Type 2 diabetes and cardiovascular disease.</p><p><a href="http://doi.org/10.1016/j.jada.2008.12.019" target="_blank" rel="noopener noreferrer">Black and Latinx people are disproportionately affected by obesity, Type 2 diabetes and cardiovascular disease</a>, all of which are linked to poor nutrition. Thus, it is not a coincidence that <a href="https://www.cdc.gov/mmwr/volumes/69/wr/mm6933e1.htm" target="_blank" rel="noopener noreferrer">these groups have suffered more deaths from COVID-19</a> compared with whites. This is the case not only in the U.S. but also <a href="https://www.washingtonpost.com/world/europe/blacks-in-britain-are-four-times-as-likely-to-die-of-coronavirus-as-whites-data-show/2020/05/07/2dc76710-9067-11ea-9322-a29e75effc93_story.html" target="_blank" rel="noopener noreferrer">in Britain</a>.</p>
Discovering Microbes That Predict COVID-19 Severity<p>The COVID-19 pandemic has inspired me to shift my research and explore the role of the gut microbiome in the overly aggressive immune response against SARS-CoV-2 infection.</p><p>My colleagues and I have hypothesized that critically ill SARS-CoV-2 patients with conditions like obesity, Type 2 diabetes and cardiovascular disease exhibit an altered gut microbiome that aggravates <a href="https://theconversation.com/exercise-may-help-reduce-risk-of-deadly-covid-19-complication-ards-136922" target="_blank" rel="noopener noreferrer">acute respiratory distress syndrome</a>.</p><p>Acute respiratory distress syndrome, a life-threatening lung injury, in SARS-CoV-2 patients is thought to develop from a <a href="http://doi.org/10.1016/j.cytogfr.2020.05.003" target="_blank" rel="noopener noreferrer">fatal overreaction of the immune response</a> called a <a href="https://theconversation.com/blocking-the-deadly-cytokine-storm-is-a-vital-weapon-for-treating-covid-19-137690" target="_blank" rel="noopener noreferrer">cytokine storm</a> <a href="http://doi.org/10.1016/S2213-2600(20)30216-2" target="_blank" rel="noopener noreferrer">that causes an uncontrolled flood</a> <a href="http://doi.org/10.1016/S2213-2600(20)30216-2" target="_blank" rel="noopener noreferrer">of immune cells into the lungs</a>. In these patients, their own uncontrolled inflammatory immune response, rather than the virus itself, causes the <a href="http://doi.org/10.1007/s00134-020-05991-x" target="_blank" rel="noopener noreferrer">severe lung injury and multiorgan failures</a> that lead to death.</p><p>Several studies <a href="https://doi.org/10.1016/j.trsl.2020.08.004" target="_blank" rel="noopener noreferrer">described in one recent review</a> have identified an altered gut microbiome in patients with COVID-19. However, identification of specific bacteria within the microbiome that could predict COVID-19 severity is lacking.</p><p>To address this question, my colleagues and I recruited COVID-19 hospitalized patients with severe and moderate symptoms. We collected stool and saliva samples to determine whether bacteria within the gut and oral microbiome could predict COVID-19 severity. The identification of microbiome markers that can predict the clinical outcomes of COVID-19 disease is key to help prioritize patients needing urgent treatment.</p><p><a href="https://doi.org/10.1101/2021.01.05.20249061" target="_blank" rel="noopener noreferrer">We demonstrated</a>, in a paper which has not yet been peer reviewed, that the composition of the gut microbiome is the strongest predictor of COVID-19 severity compared to patient's clinical characteristics commonly used to do so. Specifically, we identified that the presence of a bacterium in the stool – called <em>Enterococcus faecalis</em>– was a robust predictor of COVID-19 severity. Not surprisingly, <em>Enterococcus faecalis</em> has been associated with <a href="https://doi.org/10.1053/j.gastro.2011.05.035" target="_blank" rel="noopener noreferrer">chronic</a> <a href="https://doi.org/10.1016/S0002-9440(10)61172-8" target="_blank" rel="noopener noreferrer">inflammation</a>.</p><p><em>Enterococcus faecalis</em> collected from feces can be grown outside of the body in clinical laboratories. Thus, an <em>E. faecalis</em> test might be a cost-effective, rapid and relatively easy way to identify patients who are likely to require more supportive care and therapeutic interventions to improve their chances of survival.</p><p>But it is not yet clear from our research what is the contribution of the altered microbiome in the immune response to SARS-CoV-2 infection. A recent study has shown that <a href="https://doi.org/10.1101/2020.12.11.416180" target="_blank" rel="noopener noreferrer">SARS-CoV-2 infection triggers an imbalance in immune cells</a> called <a href="https://doi.org/10.1111/imr.12170" target="_blank" rel="noopener noreferrer">T regulatory cells that are critical to immune balance</a>.</p><p>Bacteria from the gut microbiome are responsible for the <a href="https://doi.org/10.7554/eLife.30916.001" target="_blank" rel="noopener noreferrer">proper activation</a> <a href="https://doi.org/10.1126/science.1198469" target="_blank" rel="noopener noreferrer">of those T-regulatory</a> <a href="https://doi.org/10.1038/nri.2016.36" target="_blank" rel="noopener noreferrer">cells</a>. Thus, researchers like me need to take repeated patient stool, saliva and blood samples over a longer time frame to learn how the altered microbiome observed in COVID-19 patients can modulate COVID-19 disease severity, perhaps by altering the development of the T-regulatory cells.</p><p>As a Latina scientist investigating interactions between diet, microbiome and immunity, I must stress the importance of better policies to improve access to healthy foods, which lead to a healthier microbiome. It is also important to design culturally sensitive dietary interventions for Black and Latinx communities. While a good-quality diet might not prevent SARS-CoV-2 infection, it can treat the underlying conditions related to its severity.</p><p><em><a href="https://theconversation.com/profiles/ana-maldonado-contreras-1152969" target="_blank">Ana Maldonado-Contreras</a> is an assistant professor of Microbiology and Physiological Systems at the University of Massachusetts Medical School.</em></p><p><em>Disclosure statement: Ana Maldonado-Contreras receives funding from The Helmsley Charitable Trust and her work has been supported by the American Gastroenterological Association. She received The Charles A. King Trust Postdoctoral Research Fellowship. She is also member of the Diversity Committee of the American Gastroenterological Association.</em></p><p><em style="">Reposted with permission from <a href="https://theconversation.com/a-healthy-microbiome-builds-a-strong-immune-system-that-could-help-defeat-covid-19-145668" target="_blank" rel="noopener noreferrer" style="">The Conversation</a>. </em></p>
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