Environmental Health | Health Commentary

Without the Wilderness, There Can Be No Wilderness Medicine

Sat, 23 Aug 2008 12:05:09 -0400

An open letter to the presidential candidates

In this 2008 United States presidential campaign, as the two main candidates, Barack Obama and John McCain, are being scrutinized by voters and analysts for their strengths and weaknesses, largely related to the war in Iraq and the U.S. economy, we wish to remind the candidates that we are at a defining moment for the environment. Population growth, climate change, consumption of fossil fuels, air and water pollution, and loss of biodiversity, to name a few, are not going to abate without concerted efforts, sacrifice, and political will. If either candidate wishes to fulfill his responsibility to America and the rest of the world, then he will need to make significant progress on these issues without concern for special interests, popularity, or re-election. Obama professes to be the candidate for change, and McCain says that he has wisdom bred of experience. Either way, they both need to halt the destruction of our planet and promote active environmental preservation, or they will continue to lead future generations to a precipice from which they cannot retreat.

True wilderness is a surrogate for every blade of grass, tree, or pond in a park. Wilderness medicine is medicine for the outdoors, predicated upon the notion that there will be unspoiled, unpolluted, and unencumbered forests, mountains and oceans to support our physical and emotional needs. We cannot conceive of wilderness medicine without the wilderness. The wilderness is shrinking at an alarming rate, and the most unnecessary causes are created by the activities of man. Every president since Richard Nixon has spoken to the nation about our concerning oil addiction, yet we continue to consume irreplaceable natural fuels, generate unprecedented tons of pollutants, ruin natural habitats, and endanger species. To ignore this situation or attribute it to natural cycles is dishonest, self-serving, uninformed, or ignorant.

Let us briefly review some of the environmental records and key environmental positions of these men, so that it can be clear that despite the rhetoric spun by their speechwriters, neither man should lay claim to having been a champion of the environment. At best, their past efforts have been helpful, but certainly not heroic, at a time when our world needs heroes.

Barack Obama

1. Introduced the Healthcare for Hybrids Act, which would have the federal government help cover health care costs for retired U.S. autoworkers in exchange for domestic auto companies investing at least 50 percent of the savings into production of more fuel efficient vehicles.
2. Co-sponsored the Coal to Liquid Fuel Promotion Act, supporting liquefied coal only if it emits 20 percent less carbon over its lifecycle than do conventional fuels.
3. Passed legislation with Senator Jim Talent (R-MO) to give gas stations a tax credit for installing E85 ethanol refueling pumps.
4. Worked with Senator Jim Jeffords (I-VT) to introduce the High Performance Green Buildings Act, which would increase the energy efficiency of federal buildings and schools.
5. Sponsored an amendment that became law providing $40 million for commercialization of a combined flexible fuel vehicle/hybrid car within five years.
6. Introduced legislation to enact a National Low Carbon Fuel Standard that will reduce lifecycle greenhouse gas emissions of passenger vehicle fuels sold in the U.S. by 10% in 2010 and require additional reductions of 1% annually thereafter.
7. Has opposed a summer “gas tax holiday” proposed by other candidates. However, Obama has recently proposed releasing 10% of the Strategic Petroleum reserve in order to lower oil prices. It is not clear whether or not he supports offshore drilling.
8. Calls for cutting U.S. carbon dioxide emissions 80% below 1990 levels by 2050 through a cap and trade system that would auction off 100% of emissions permits to finance development of clean energy technology; 25% of U.S. electricity to come from renewable sources by 2025; investment of $150 billion over 10 years for renewables, biofuels, and other “clean tech”; all new buildings in the U.S. to be carbon neutral by 2030; reducing U.S. oil consumption by at least 35% by 2030.
9. Advocates U.S. re-engagement with the U.N. Framework Convention on Climate Change (UNFCCC) and leadership of a new Global Energy Forum (G8 members plus five of the world’s largest emitters) to combat global climate change.

Summary: Obama states, “I believe that global warming is not just the greatest environmental challenge facing our planet – it is one of the greatest challenges of any kind. It is an issue that we ignore at our peril and at even greater peril for our children, grandchildren, and many impoverished global populations. Combating global warming will be a top priority of my presidency, and I will attend to it personally.” Obama’s words are strong, but he has not yet been in office long enough to establish a significant track record. If he is elected, we can only hope that actions will follow.

John McCain

1. Championed legislation to limit aircraft flights over the Grand Canyon.
2. Was absent for key votes on fuel efficiency, wildlife preservation, and mining.
3. Has sponsored or co-sponsored environmental protection bills related to protecting whales, improving fuel efficiency, and awarding tax credits for energy efficiency.
4. Held balanced, scientific climate hearings; has admitted the presence of anthropogenic climate change.
5. With Senator Joe Lieberman, drafted the first economy-wide cap and trade bill for carbon emissions (Climate Stewardship Act), which did not pass in 2003.
6. Re-introduced the climate bill in 2005, with added subsidies for nuclear energy; this was voted down.
7. Opposed drilling in the Arctic National Wildlife Refuge, but supports offshore oil and natural gas drilling.
8. Filibustered to oppose the 2003 energy bill, which advocated use of fossil fuels.
9. Suggested suspending the federal gasoline tax.

Summary: John McCain can best be characterized as inconsistent. He has had moments of appearing to be concerned about the environment, but these do not mesh well with his voting attendance record. He still is guided to a certain extent by partisan considerations. He appears to be somewhat enlightened in comparison to other Republicans, but is in no sense an expert on environmental issues, and has not made an extraordinary effort to surround himself with thought leaders. He has at least one strategist who understands the importance of environmental issues with voters, but McCain himself is a wild card on matters pertaining to land and conservation issues.

The League of Conservation Voters (LCV) provides objective, factual information about the most important environmental legislation and the corresponding voting records of all members of Congress. It offers a consensus of experts from more than 20 respected environmental and conservation organizations. Congressional members are graded on key votes, with 100 representing a perfect score. Obama’s lowest LCV score was 67 and highest 100 (2006), with a lifetime score (career average during years in office) of 86. McCain has scored as low as 0 (2007) and as high as 67, with a lifetime score of 24.

One of these men will be elected the next President of the United States. Because we hope that both are sufficiently intelligent and perceptive to recognize the truth and be cognizant of the urgent need for environmental remediation, we respectfully ask our next President to not only honor his campaign promises to prioritize the environment, but to consider the following bipartisan course of action:

1. Create an independent commission to gather the science and report each year to the nation the state of the global environment. Within that report, the following, at a minimum, should be addressed: global warming, depletion of stratospheric ozone, destruction of forests, polar melting, deficiencies in water production and sanitation, human population growth and dynamics, and the economic, social, and medical impacts of all of the aforementioned issues.
2. Create a National Institute for the Environment (NIE) with a budget sufficient to support epidemiology, basic science, and applied research in environmental science.
3. Create an Environmental Corps for college graduates, who will serve a paid 2 to 4-year tour of public service duty in exchange, year for year, for college education funding.
4. Pass legislation that will definitively create alternate (to fossil fuels) energy sources for the U.S. no later than a decade from now, integrating the principles of a Renewable Portfolio Standard, such that the consumption of fossil fuels can be decreased to a situation of net energy gain from all sources by the year 2018.
5. Eliminate financial support for any federal or state entity, program, or business, without exception, that does not have a neutral carbon footprint by the year 2013.
6. Codify and institute a progressive carbon cap and trade policy.
7. Remove all tax breaks from fossil fuel-consuming industries.
8. Adjust utility regulation to promote fuel efficiency.
9. Provide federal dollars to subsidize free fuel-efficient public transit.
10. Impose an average 40 mile-per-gallon minimum for all newly manufactured passenger cars driven in the U.S. by the year 2018.
11. Provide dollar for dollar tax credits to persons who retrofit or construct fuel-efficient dwellings.
12. Consider it the obligation of the U.S. to take a leadership position and collaborate with other nations to eradicate potable drinking water deficiencies worldwide by the year 2018.
13. Cease and desist on drilling for oil, mining for coal, logging for lumber, or any other environmental predatory practice in any current and future protected natural habitat, including the Arctic National Wildlife Refuge.

These are difficult mandates that will require inspirational efforts and political fortitude, and sacrifice on the part of all citizens. The President of the United States leads the greatest free nation in the world, and as such, carries more obligation than do other world leaders. If other nations are not yet willing to “step up to the plate” and do their fair share, then our country must lead by example. There will undoubtedly be inconvenience and economic reconfiguration, such that certain industries will mount mighty challenges to these proposals. We are used to that sort of thinking – after all, the tobacco industry has been killing people for years with little remorse, despite all the evidence about the health effects of tobacco. But killing millions of smokers with cigarettes does not pose irrevocable harm to mankind, only to the unfortunate victims and their families of cancer and cardiovascular disease. War and pandemics are serious matters, but in our estimation, environmental issues are of a far greater magnitude, perhaps of a permanent catastrophic nature over a relatively short period of time. We do not see a requirement to unequivocally predict the future, because preserving the planet can only be good, whether or not it is absolutely necessary at this particular moment. When we see a patient with accelerated hypertension, we control it before we are called upon to treat that same patient’s heart attack or stroke. A climber who has a headache and cannot walk a straight line is brought to a lower altitude before his brain swells further and he cannot be saved. We call upon our next President to assemble the very best clinicians to treat our planetary patient, before every nation is forced to be put on life support.

Paul S. Auerbach, MD, MS, FACEP, FAWM
Luanne Freer, MD, FACEP, FAWM

Not all Fish are Created Equal - And Then There's Tilapia

Mon, 28 Jul 2008 10:56:59 -0400

Fastest growing seafood choice has doubtful benefits

Eat fish, it's brain food...Don't it fish, it might have mercury and PCBs...Do eat fish, it's high in protein and low in saturated fat...Don't eat fish, it may be imported from China, laden with parasites and pesticides. The news on fish is as confusing as any public health message today. The dual discovery that methyl mercury in fish is unhealthy but that fish oils (omega-3 fatty acids) are very healthy has led to arguments among normally very reasonable scientists about how much fish to eat. The discussion needs to shift from "whether" to "which" - it's not whether to eat fish, but which fish are safest and healthiest to eat.

It turns out that some species like swordfish are a bad deal for your body because they are low in omega-3 FAs but are high in mercury. Salmon is just the opposite and so is generally a good choice, especially if you can find it in your budget to eat wild salmon . They are lower in dioxins than farmed salmon. In between, the extremes of swordfish and salmon there are lots of common fish like sushi and shrimp and canned tuna and fish sticks - these all have their own ratio of omega-3 FA to methyl mercury. Fish advisories issued by state agencies are starting to pay attention to this and offer species-specific consumption advice (e.g., eat more canned light tuna than canned white tuna because the white tuna is 3 times higher in mercury). The Connecticut Dept of Public Health has a very helpful flyer showing which species to eat how often.

Of course we know that fish are more than just good oils and bad contaminants. There are other beneficial nutrients such as protein, iodide, selenium and iron. But recent evidence on tilapia raises questions about another ingredient in fish, the polyunsaturated omega-6 FAs. Researchers at Wake Forest University have called tilapia worse for your health than hamburger because of its high omega-6 content. There is evidence that omega-6 FAs can block the beneficial effects of omega-3 FAs and lead to greater stress and inflammation and higher risks of diabetes and heart disease. Remember, we are not talking about saturated fat in meat here, the longstanding villian of our blood vessels. Now we are splitting hairs within the category of supposedly good lipids, the polyunsaturateds.

So, why have the Wake Forest researchers targeted tilapia? They found that farmed tilapia are raised on a corn-meal based diet, which leads to them be high in omega-6 and low in omega-3 FAs. Their cheap diet also makes them inexpensive to buy. In contrast, salmon are raised on fish meal and so are high in omega-3 FAs, low in omega-6, but are a more expensive purchase.

So, should America give up farmed tilapia? Hardly. That would also mean giving up salad dressing and cooking oils, both rich in omega-6 and low in omega-3 FAs. However, we should be concerned if tilapia becomes so popular because of its cost that it becomes a staple food. People need to get omega-3 FAs and fish are pretty much the only option. We don't want to waste all our fish-eating on a species that contains so little omega-3 and such a bad fish oil ratio - it's something like filling up your diet with empty calories. Farmed tilapia is low in contaminants and does have other fish nutrients, so an occasional tilapia meal makes sense. But mix in some salmon, herring, trout, shellfish, and light tuna. And taking an omega-3 FA supplement every day is a good way to make sure you are getting enough of this critical nutrient, regardless of how much tilapia you may choose to eat.

Are Cosmetics in Need of a Makeover?

Wed, 18 Jun 2008 17:40:01 -0400

Emerging evidence suggests personal care products can affect hormonal balance in men and women

Healthy skin or healthy hormones - is that the choice our bath, body and cosmetics products are forcing us to make? In our looks-fixated, aging averse society, we hold our personal care products in great esteem. “Moisturize away dry skin and wrinkles!” We dutifully obey the marketing as we apply these creamy concoctions into every crevice. However, now the emphasis on skin vigor is becoming tempered with worry over endocrine health as ingredients in these products are shown to be hormonally active. And its not just moisturizing lotion: cosmetics, fragrances, deodorant and even sun block need closer scrutiny.

The reality is that in any given product, 90% or more of the ingredients are non-toxic. The typical surfactants, emulsifiers, oils and fragrances are generally safe. However, as with many things, the devil is in the details and it’s the small percentage items which are most worrisome. The question is whether there is enough of a chemical dose in every squirt to add up to an endocrine disrupting effect. Emerging evidence suggests that in certain cases, this can occur.

What type of endocrine effect might arise from daily use of personal care products? The predominant trend appears to be towards feminization: making boys less male and increasing a women’s estrogen dose to the point where it becomes a risk for breast cancer. It turns out that the most common endocrine disruptors in our consumer products either mimic estrogen or inhibit testosterone, and thus have the potential to tip the balance toward female traits. Reports of the feminization of fish in water bodies that receive sewage outfalls are increasingly common. The estrogens in sewage are varied, some appear to come from our cleaning products (e.g., alkylphenol ethoxylate in dish soap and detergent), some from body products such as sunscreen, and some from the estrogens women excrete from taking birth control pills. Fish feminization is the hormonal handwriting on the wall, a signal that we are using estrogenic products capable of shifting the balance of nature, both external and internal, to female traits.

This is not good news for the male of our species, whose earliest sexual development occurs in a female, estrogenic environment, the womb. To counteract this, there are critical periods in which the primitive fetal testes secretes testosterone; these exquisitely timed pulses of male hormone ensure proper development of the penis and testicles. Unfortunately, phthalates, a common ingredient in fragrances, cosmetics, deodorant and lotions, impair the male gonad and prevents the secretion of testosterone; the result is that our boys may be less male (feminized) at birth. This is the tentative conclusion stemming from a 2005 study of 85 mother-child pairs in which the amount of phthalate in the mother during pregnancy was a good predictor of gonadal measurements in the male offspring. This association is strengthened by the similar findings in laboratory animals. Does this explain the increasing rates of penile birth defects (hypospadias) and male infertility? Clearly more study is needed, but the precautionary approach used by the Europeans to remove the most worrisome phthalates from personal care products is a step in the right direction.

Then we have the evidence from a Colorado doctors office of three boys who developed breast enlargement, apparently from an overuse of common lotions and hair gels. Testing of ingredients in these products found that the scented oils, lavender and tea tree, are weakly estrogenic, leading to the supposition that these are what caused such inappropriate breast growth. However, given the mixture of hormonally active agents that can be present inside any pump bottle, no one knows the totality of the estrogenic dose to these boys. Fortunately, breast size returned to normal when the products were discontinued.

One could go on to describe our unnecessary exposure to parabens and benzophenones in lotion and sunblock, trichlosan (antibacterial in everything from toothpaste to dish soap and deodorant) and the still too prevalent bis-phenol A. This latter chemical was designed in the early 1930s as a synthetic estrogen but instead has ended up in food can liners and polycarbonate bottles. The point is that when all these tiny doses of external estrogen are bundled together with the phytoestrogens naturally in food, we may be nudging girls towards breast cancer and boys towards infertility. U.S. officials so far seem to consider any one product or type of chemical too trivial to regulate. However, there is a clear need for wholistic thinking and an aggressive research program to determine if we have created an iceberg of disease in a sea of endocrine disruption.