Chronic Disease amp Chronic Disease amp Environmental Environmental

ToxinsToxinsEmerging Links Emerging Links

Jenny E Jenny E Pompilio MDPompilio MD

wwworegonpsrorgwwworegonpsrorg

Goals TodayGoals Today

Summarize areas of concerns about Summarize areas of concerns about Environmental ToxinsEnvironmental Toxins

Healthy People 2010Healthy People 2010 CDCrsquos Natrsquol Report on Human Exposure CDCrsquos Natrsquol Report on Human Exposure Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos Women of Child-bearing Age and Women of Child-bearing Age and

MercuryMercury Oregon Climate Oregon Climate Everyday practiceEveryday practice

Chronic Disease a Chronic Disease a SnapshotSnapshot

1 overall killer in US (7 of 10 deaths 1 overall killer in US (7 of 10 deaths per year)per year)

~90-100 million Americans (13 of ~90-100 million Americans (13 of population) population)

gt75 of US $14 trillion medical care gt75 of US $14 trillion medical care costs costs

Account for 13 of the years of potential Account for 13 of the years of potential life lost before age 65 life lost before age 65

Modifiable Risk Factors amp Modifiable Risk Factors amp Death Death

United States 2000United States 2000Percentage of all deathsPercentage of all deathsTobacco use 181Tobacco use 181

Poor dietlack of exercise 166Poor dietlack of exercise 166

Alcohol use 35Alcohol use 35

Infectious agents 31Infectious agents 31

Pollutantstoxins 23Pollutantstoxins 23

Motor vehicle crashes 18Motor vehicle crashes 18

Firearms 12Firearms 12

Risky sexual behavior 08Risky sexual behavior 08

Illicit drug use 07Illicit drug use 07

JAMA 2004 291 1238-45

Poor environmental quality accounts Poor environmental quality accounts for 25 of all preventable world for 25 of all preventable world

illnessillness

WHO 1997

Environmental Illness a Environmental Illness a SnapshotSnapshot

Environmental illness Environmental illness in US childrenin US children

$55 billionyear$55 billionyear Lead poisoningLead poisoning

AsthmaAsthma

CancerCancer

Developmental DisabilitiesDevelopmental Disabilities

EHP 2002 110 (7) 721-728

Healthy People 2010Healthy People 2010

National objectivesNational objectives Most significant Most significant

preventable preventable threats to health threats to health amp goals to reduce amp goals to reduce themthem

Includes Includes environmental environmental health objectiveshealth objectives

Providers role in Providers role in preventionprevention

Healthy People 2010 Toxic Healthy People 2010 Toxic WastesWastes

Lower elevated blood lead levels to Lower elevated blood lead levels to 11

Minimize risks from hazardous sitesMinimize risks from hazardous sites Reduce pesticide exposuresReduce pesticide exposures Reduce toxic pollutants produced Reduce toxic pollutants produced

disposed of treated or used for disposed of treated or used for energy recoveryenergy recovery

Increase recycling of solid waste to Increase recycling of solid waste to 3838

State of Knowledge Our State of Knowledge Our Chemical EnvironmentChemical Environment

gt80000 chemicals in gt80000 chemicals in Federal inventoryFederal inventory

2000 to 3000 NEW 2000 to 3000 NEW chemicals per yearchemicals per year

gt4 billion lbs released gt4 billion lbs released into environment yearly into environment yearly 72 million lbs of 72 million lbs of recognized carcinogens recognized carcinogens

Basic Screening Basic Screening Information Data Set Information Data Set (SIDS) avg $205000 per (SIDS) avg $205000 per chemicalchemical

Hazard Data - Chemicals Hazard Data - Chemicals Produced Produced

gt 1 Million PoundsYear gt 1 Million PoundsYear

0 10 20 30 40 50 60 70 80 90 100

Percentage Tested

Acute Toxicity

Environmental Fate

Ecotoxicity

Mutagenicity

Chronic Toxicity

ReproductiveToxicity

Full Set of BasicToxicity Tests

Medical WasteMedical Waste

6000 US hospitals~2 million 6000 US hospitals~2 million tons waste per year tons waste per year

Clinics and doctorsrsquo offices add 700000 Clinics and doctorsrsquo offices add 700000 tonstons

EPA regulations weak-HCWHh2eEPA regulations weak-HCWHh2e 850000 tons incinerated850000 tons incinerated

Pollutants inc dioxin Hg cadmium Pollutants inc dioxin Hg cadmium and Pband Pb

Segregation amp alternatives to Segregation amp alternatives to incineration incineration would cost 93 would cost 93 centspatientdaycentspatientday

Our Chemical EnvironmentOur Chemical Environment

1305 Superfund sites1305 Superfund sites 25002500 are are eligible eligible gt80kgt80k hazardous sites hazardous sites knownknown

~11 million people live within 1 mile~11 million people live within 1 mile ~25 live within 4 miles~25 live within 4 miles OR ranks 24OR ranks 24-12 Superfund sites-12 Superfund sites 3 in PDX3 in PDX Harbor Oil Portland Harbor Oil Portland

Harbor Harbor McCormick amp Baxter McCormick amp Baxter Creosoting Co Creosoting Co

Multnomah amp Washington CoMultnomah amp Washington CoShared Pollutants 2002Shared Pollutants 2002

Links to Disease Links to Disease

Methanol (gt240k lbs)Methanol (gt240k lbs)

StrongStrong ATN amp vision problems ATN amp vision problems

GoodGood Pancreatitis amp Pancreatitis amp Parkinsonrsquosmovement disorders Parkinsonrsquosmovement disorders

Ammonia (gt100k lbs)Ammonia (gt100k lbs)

StrongStrong Asthma acutechronic bronchitis Asthma acutechronic bronchitis olfactory disorders amp rhinitis olfactory disorders amp rhinitis

GoodGood Pulmonary edema Pulmonary edema

Links to Disease contLinks to Disease cont

Xylene (gt95k lbs) amp Toluene (gt83k lbs)Xylene (gt95k lbs) amp Toluene (gt83k lbs) GoodGood Scleroderma arrhythmias menstrual Scleroderma arrhythmias menstrual

do cognitive impairment hearing loss amp do cognitive impairment hearing loss amp fetal death (miscarriagestillbirth)fetal death (miscarriagestillbirth)

Glycol Ethers (gt20k lbs)Glycol Ethers (gt20k lbs) StrongStrong Reduced male fertility abnormal Reduced male fertility abnormal

sperm (morphology motility amp count) amp fetal sperm (morphology motility amp count) amp fetal death (miscarriagestillbirth) death (miscarriagestillbirth)

GoodGood ATN reduced female fertility general ATN reduced female fertility general congenital and craniofacial malformationscongenital and craniofacial malformations

National Report on Human National Report on Human Exposure to Environmental Exposure to Environmental

Chemicals Chemicals (CDC 705)(CDC 705)

Random selection from NHANES Random selection from NHANES surveysurvey

148 chemicals from 2001-2002 inc 148 chemicals from 2001-2002 inc data on 116 chemicals from 1999-data on 116 chemicals from 1999-20002000

Criteria for chemical inclusion Criteria for chemical inclusion wide exposure wide exposure serious health effects serious health effects adequate blood amp urine samples adequate blood amp urine samples efficacy of attempts to reduce efficacy of attempts to reduce

exposure exposure availability of reliable bio-monitoring availability of reliable bio-monitoring

methodmethod

CDC Report GoalsCDC Report Goals

Which chemicals are present amp Which chemicals are present amp concentrations concentrations

How many people have levels above How many people have levels above known toxicity thresholdsknown toxicity thresholds

Establish reference ranges Establish reference ranges Determine if levels are higher in at Determine if levels are higher in at

risk populations risk populations Track trends over time Track trends over time Set priorities for researchSet priorities for research

CDC Report HighlightsCDC Report Highlights

First time data for 38148 chemicalsFirst time data for 38148 chemicals BLL declining 44 of children early BLL declining 44 of children early

1990s 16 of children from 1999-1990s 16 of children from 1999-20022002

Hg in women of childbearing age Hg in women of childbearing age 57 have concerning levels57 have concerning levels

Pyrethroid insecticides (common Pyrethroid insecticides (common home use) 76 of populationhome use) 76 of population

Highlights contHighlights cont

Levels of 3 toxic pesticides- Levels of 3 toxic pesticides- Aldrin Dieldrin amp Endrin-very low Aldrin Dieldrin amp Endrin-very low

29 Dioxin-like compounds levels are 29 Dioxin-like compounds levels are declining declining

Cadmium 5 population gt20yrs age Cadmium 5 population gt20yrs age levels near toxic limit (kidney dz low levels near toxic limit (kidney dz low BMD)BMD)

Phthalates widespread higher in Phthalates widespread higher in women amp childrenwomen amp children

Limitations of Current DataLimitations of Current Data

Exposure to chemical mixtures Exposure to chemical mixtures common-research more complexcommon-research more complex

Data available for only minority Data available for only minority single agentssingle agents

Epidemiological amp animal studies Epidemiological amp animal studies often only data availableoften only data available

Result links btw Chronic Diseases amp Result links btw Chronic Diseases amp low dose chronic complex exposures low dose chronic complex exposures hard to ldquoproverdquohard to ldquoproverdquo

PROVEN HARM

PARTIALLY PROVEN

NOT YET RECOGNIZED

FOREVER UNRECOGNIZED

THE TOXIC ICEBERG________________________________________

Oregoniansrsquo HealthOregoniansrsquo Health12 CHEMICALS OF KEY CONCERN12 CHEMICALS OF KEY CONCERN 1048698 1048698 acroleinacrolein 1048698 1048698 benzenebenzene 1048698 1048698 benzo(a)pyrenebenzo(a)pyrene 1048698 1048698 bisphenol-Abisphenol-A 1048698 1048698 brominated flame retardants (BFRs)brominated flame retardants (BFRs) 1048698 1048698 dieseldiesel 1048698 1048698 dioxindioxin 1048698 1048698 formaldehydeformaldehyde 1048698 1048698 leadlead 1048698 1048698 mercurymercury home amp garden pesticideshome amp garden pesticides 1048698 1048698 phthalatesphthalates

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

A 52 yr-old pt co increasing tremor A 52 yr-old pt co increasing tremor On PE the tremor is pill-rolling and On PE the tremor is pill-rolling and resolves with intention +Romberg resolves with intention +Romberg sign unstable tandem gaitsign unstable tandem gait

You make a preliminary diagnosis of You make a preliminary diagnosis of early Parkinsonrsquos diseaseearly Parkinsonrsquos disease

Wife mentions reading about Wife mentions reading about environmental links to PD pt is a environmental links to PD pt is a farmer and has used pesticides for farmer and has used pesticides for years Could this be related to his years Could this be related to his diseasedisease

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

Paraquat rotenone organophosphates Paraquat rotenone organophosphates dieldrin and fungicides maneb amp dieldrin and fungicides maneb amp mancozeb implicatedmancozeb implicated

MPTP a designer heroin-like drug MPTP a designer heroin-like drug causes Parkinsonian syndrome in causes Parkinsonian syndrome in addictsaddicts

Higher incidence in industrialized Higher incidence in industrialized countries greatest risk in rural countries greatest risk in rural areasfarms prolonged pesticide useareasfarms prolonged pesticide use

Case control studies herbicide or Case control studies herbicide or insecticide exposure 3-4x likelyinsecticide exposure 3-4x likely

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

2005 Brown T et al Meta-analysis 2005 Brown T et al Meta-analysis of epidemi-ologic amp toxicologic of epidemi-ologic amp toxicologic studies since 1983 studies since 1983

Verified most of these links noting Verified most of these links noting limitations in study designs limitations in study designs

Conclusion ldquogeneric association btw Conclusion ldquogeneric association btw pesticide exposure amp PD exists but pesticide exposure amp PD exists but is insufficient tohellipconcludehellipa causal is insufficient tohellipconcludehellipa causal relationshiprdquo relationshiprdquo

Pesticides Genes amp PDPesticides Genes amp PD

Dr W Langston of Parkinsonrsquos Dr W Langston of Parkinsonrsquos Institute ldquoAccelerating Research on Institute ldquoAccelerating Research on Genes and Environment in Genes and Environment in Parkinsonrsquos Diseaserdquo (2005)Parkinsonrsquos Diseaserdquo (2005)

Two PD studies underway one in Two PD studies underway one in pesticide applicators other in two pesticide applicators other in two CA counties with known heavy CA counties with known heavy exposureexposure

Other Health Impacts of Other Health Impacts of PesticidesPesticides

ArrhythmiasArrhythmiasAsthmaAsthmaLymphomas Brain tumorsLymphomas Brain tumorsAbnormal sperm countsAbnormal sperm countsBirth defects amp developmental delaysBirth defects amp developmental delaysHyperactivity amp behavioral problemsHyperactivity amp behavioral problemsDecreased endurance amp coordinationDecreased endurance amp coordinationNeurocognitive problemsNeurocognitive problemsPeripheral neuropathiesPeripheral neuropathies

Pesticides a Persistent Pesticides a Persistent ProblemProblem

Major classesMajor classes insecticides fungicides insecticides fungicides herbicides rodenticidesherbicides rodenticides

1997 Market1997 Market US $119 billion World $37 US $119 billion World $37 billionbillion

HistoryHistory synthetic-new to humans amp synthetic-new to humans amp environment since 1940s gt800 licensed environment since 1940s gt800 licensed ldquoactiverdquo ingredientsldquoactiverdquo ingredients

Manufacturers Manufacturers Bayer Aventis other drug Bayer Aventis other drug coco

Inherent toxicityInherent toxicity 140 pesticides considered 140 pesticides considered neurotoxic 37 are used on food ampor feedneurotoxic 37 are used on food ampor feed

Insecticide Sites of Insecticide Sites of ActionAction

Enzymes

Axonal Membranes

Ions (Na+ K+ Ca++ Cl-)

Enzymes

Neurotransmitters

Organochlorines

Pyrethroids

Casarett and Doullrsquos Toxicology The Basic Science of Poisons 5th Edition Ed Klaassen CD

McGraw-Hill New York 1996 P 649

Organophosphorus and

Carbamate Esters

Organophosphate PesticidesOrganophosphate PesticidesOccurrence and distribution in surface amp

ground water of the United States 1992-97

httpgawaterusgsgovpublicationsabstractsofr00-187html

Background Pesticide Background Pesticide Exposures WidespreadExposures Widespread

Reported useReported use 98 of families 80 during 98 of families 80 during pregnancypregnancy

In HumansIn Humans detectable chlorpyrifos detectable chlorpyrifos metabolites in 92 of childrenrsquos 82 of metabolites in 92 of childrenrsquos 82 of adultsrsquo urine samplesadultsrsquo urine samples

In FoodIn Food residues of at least one pesticide on residues of at least one pesticide on 72 fruits amp vegetables72 fruits amp vegetables

In HomesIn Homes 3 to 9 pesticide residues found3 to 9 pesticide residues found

In AirIn Air indoor levels 10-100X higher than indoor levels 10-100X higher than outdooroutdoor

In WaterIn Water gt90 stream samples 50 of gt90 stream samples 50 of wellswells

Sources of PesticidesSources of Pesticides

Household uses lawn amp garden Household uses lawn amp garden sprays exterminators flea collarssprays exterminators flea collars

Household dust (tracking in on shoes)Household dust (tracking in on shoes)

Public schools hospitals parks Public schools hospitals parks childcare facilitieschildcare facilities

Agricultural uses amp workersrsquo clothesAgricultural uses amp workersrsquo clothes

Non-organic foodsNon-organic foods

Breast milkBreast milk

Strategies to Reduces Strategies to Reduces Exposure to Home amp Garden Exposure to Home amp Garden

Pesticides in OregonPesticides in OregonPolicy SolutionsPolicy Solutions OR pesticide use reporting system OR pesticide use reporting system

(1999) finally funded 2005(1999) finally funded 2005 Educate homeowners re nontoxic Educate homeowners re nontoxic

options options Enc pet owners to use flea combs and Enc pet owners to use flea combs and

vacuuming to control fleasvacuuming to control fleas Enc public places to use Integrated Enc public places to use Integrated

Pest Management (IPM) ie Pesticide Pest Management (IPM) ie Pesticide Free ParksFree Parks

What YOU Can Do about What YOU Can Do about PesticidesPesticides

Advise PatientsAdvise Patients Regularly dustRegularly dust Use Integrated Pest Management Use Integrated Pest Management Cleanremove shoes outsideCleanremove shoes outside Keep contaminated clothes separateKeep contaminated clothes separate Buy sustainably grown foodBuy sustainably grown food Store food in secure nontoxic Store food in secure nontoxic

containerscontainers

Mercury amp Women of Mercury amp Women of Childbearing AgeChildbearing Age

A 32 yo G0P0 woman of A 32 yo G0P0 woman of childbearing age (WCBA) childbearing age (WCBA) presents for annual PE presents for annual PE

PMH negativePMH negative

Social hx husband is Social hx husband is recreational fisherman recreational fisherman

Contemplating pregnancy Contemplating pregnancy

Should she avoid fish Should she avoid fish because of mercury risks because of mercury risks to the fetusto the fetus

Mercury amp WCBAMercury amp WCBA

gt10gt10 of WCBA exceed safe limit of of WCBA exceed safe limit of 1ugkgday1ugkgday

5050 of women of women who eat fishwho eat fish exceed exceed limitlimit

5757 of WCBA have Hg levels of WCBA have Hg levels concerning for adverse effects concerning for adverse effects (CDC (CDC Natrsquol Report 0705Natrsquol Report 0705))

Higher risk Higher risk 300 000 childrenyear 300 000 childrenyear subsistence fishers immigrants subsistence fishers immigrants Native AmericansNative Americans

Mercury amp WCBAMercury amp WCBA

Hg enters tissues variable excretionHg enters tissues variable excretion Breast Milk PCBs DDT amp other Breast Milk PCBs DDT amp other

pesticides dioxins dibenzofurans pesticides dioxins dibenzofurans toxic flame retardants amp heavy toxic flame retardants amp heavy metals (Pb amp Hg) metals (Pb amp Hg)

No bio-accumulation in milk but No bio-accumulation in milk but levels in fish-eaters may exceed levels in fish-eaters may exceed unexposed women by 100x unexposed women by 100x

Scientific evidence indicates Scientific evidence indicates advantages of breast-feeding advantages of breast-feeding outweigh riskshellipoutweigh riskshellip

Neuro Effects of MercuryNeuro Effects of Mercury

Cerebral palsyCerebral palsy MRDDMRDD disequilibrium ataxiadisequilibrium ataxia hearing lossdeafnesshearing lossdeafness visual visual

impairmentblindnessimpairmentblindness peripheral neuropathyperipheral neuropathy parasthesiasparasthesias tremors seizures tremors seizures abnl reflexes amp muscle toneabnl reflexes amp muscle tone Psychiatric disturbances Psychiatric disturbances

Mercury a Persistent Mercury a Persistent ProblemProblem

PoisoningsPoisonings Minamata 1950s amp Iraq Minamata 1950s amp Iraq 19711971

Nationally ~Nationally ~160 tons of Hg annually160 tons of Hg annually In OregonIn Oregon ~ ~4500 lbs annually4500 lbs annually Lack of regulationLack of regulation In OR 10 facilities In OR 10 facilities

report Hg release-none has a permit or is report Hg release-none has a permit or is required to monitor emissions by staterequired to monitor emissions by state

Fish AdvisoriesFish Advisories in 2004 45 states had in 2004 45 states had gt2000 warnings Oregon lists advisories gt2000 warnings Oregon lists advisories for 12 water bodies inc Willamette for 12 water bodies inc Willamette

Atmospheric HgAtmospheric Hg

The Mercury CycleThe Mercury Cycle

MercuryMercuryDeclining Threshold of Declining Threshold of

HarmHarm

2000199019801970001

01

1

10

100

YEAR

Level associated with harmful effectRegulatory standard (maximum safe exposure or high end exposure from allowed fish contamination)

FDA WHO

EPA

ATSDR

DA

ILY

IN

TA

KE

(mic

rogr

ams

kg

day

Hg)

Sources of MercurySources of MercuryIndustrial emissions Industrial emissions

coal fired plantscoal fired plantsMunicipal amp medical Municipal amp medical

waste incineratorswaste incineratorsAbandoned Hg amp gold Abandoned Hg amp gold

minesminesNatural off-gassing Natural off-gassing Dental amalgamsDental amalgamsBioaccumulation in Bioaccumulation in

foods esp fishfoods esp fishOld thermometers BP Old thermometers BP

cuffs amp auto cuffs amp auto switchesswitches

Strategies to Reduce Strategies to Reduce Mercury Pollution in Mercury Pollution in

OregonOregonPolicy SolutionsPolicy Solutions Mercury Solutions Act of 2001Mercury Solutions Act of 2001 Ensure safe collection amp recyclingEnsure safe collection amp recycling Clean up abandoned mines and Clean up abandoned mines and

SuperfundsSuperfunds Reduce Hg emissions from health Reduce Hg emissions from health

care facilitiescare facilities Inc Hg in applicable DEQ air amp Inc Hg in applicable DEQ air amp

water permitswater permits Coal burning power plant Boardman Coal burning power plant Boardman

OR OR Implement OR Executive OrderImplement OR Executive Order

What YOU Can Do about What YOU Can Do about MercuryMercury

Advise PatientsAdvise Patients Provide Provide An Expectant Motherrsquos Guide to An Expectant Motherrsquos Guide to

Eating Fish in Oregon (DHS) Eating Fish in Oregon (DHS) in waiting in waiting roomsrooms

Rec WCBA and children avoid fish wHgRec WCBA and children avoid fish wHg Enc WCBA to consume low-fat dietEnc WCBA to consume low-fat diet Recycle old Hg thermometers Recycle old Hg thermometers

thermostats amp fluorescent light tubesthermostats amp fluorescent light tubes Have car checked for Hg switches at Have car checked for Hg switches at

participating auto shop (free participating auto shop (free replacement)replacement)

Use digital thermometers amp thermostatsUse digital thermometers amp thermostats

SummarySummary Chronic Diseases are prevalent Toxic Chronic Diseases are prevalent Toxic

exposures are possible exposures are possible preventablepreventable contributorscontributors

Pesticides amp risk of Parkinsonrsquos and Mercury Pesticides amp risk of Parkinsonrsquos and Mercury risks to WCBA are more understood than most risks to WCBA are more understood than most toxins and other chronic diseasestoxins and other chronic diseases

Apparent toxicity at high doses should be a Apparent toxicity at high doses should be a red flag for possible harm from low dose red flag for possible harm from low dose chronic exposureschronic exposures

Since ldquoproofrdquo of harm materializes slowly Since ldquoproofrdquo of harm materializes slowly generations are at risk and may be harmed generations are at risk and may be harmed before adequate regulatory response occursbefore adequate regulatory response occurs

Kaiser amp HCWHh2eKaiser amp HCWHh2e

Clean Diesel Hospital Zones ProjectClean Diesel Hospital Zones Project Healthy Food in Healthcare InitiativeHealthy Food in Healthcare Initiative Green Building PVC and DEHP free Green Building PVC and DEHP free

NICU NICU Environmentally preferable purchasing Environmentally preferable purchasing

policypolicy Making Medicine Mercury Free Award Making Medicine Mercury Free Award h2e Environmental Leadership Award h2e Environmental Leadership Award

20022002

What Can You DoWhat Can You Do

Be aware of environmental toxins amp Be aware of environmental toxins amp their possible links to chronic diseasestheir possible links to chronic diseases

Provide advice amp education on Provide advice amp education on prevention andor minimizing prevention andor minimizing exposures or refer appropriately exposures or refer appropriately

Incorporate environmental questions Incorporate environmental questions into clinical historyinto clinical history

Advocate Advocate wwwenvirohealthactionorgwwwenvirohealthactionorg

Local AdvocacyLocal Advocacy Oregon Environmental CouncilOregon Environmental Council wwwoeconlineorgwwwoeconlineorg Oregon Collaborative on Health amp Oregon Collaborative on Health amp

EnvironmentEnvironment Healthy Environment ForumsHealthy Environment Forums Oregon Center for Environmental HealthOregon Center for Environmental Health wwworegon-healthorgwwworegon-healthorg Healthcare without HarmHealthcare without Harm Hospitals for Healthy Environment (h2e)Hospitals for Healthy Environment (h2e) Oregon PSROregon PSR wwworegonpsrorgwwworegonpsrorg Environmental Health-In Harmrsquos Way Environmental Health-In Harmrsquos Way

Goals TodayGoals Today

Summarize areas of concerns about Summarize areas of concerns about Environmental ToxinsEnvironmental Toxins

Healthy People 2010Healthy People 2010 CDCrsquos Natrsquol Report on Human Exposure CDCrsquos Natrsquol Report on Human Exposure Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos Women of Child-bearing Age and Women of Child-bearing Age and

MercuryMercury Oregon Climate Oregon Climate Everyday practiceEveryday practice

Chronic Disease a Chronic Disease a SnapshotSnapshot

1 overall killer in US (7 of 10 deaths 1 overall killer in US (7 of 10 deaths per year)per year)

~90-100 million Americans (13 of ~90-100 million Americans (13 of population) population)

gt75 of US $14 trillion medical care gt75 of US $14 trillion medical care costs costs

Account for 13 of the years of potential Account for 13 of the years of potential life lost before age 65 life lost before age 65

Modifiable Risk Factors amp Modifiable Risk Factors amp Death Death

United States 2000United States 2000Percentage of all deathsPercentage of all deathsTobacco use 181Tobacco use 181

Poor dietlack of exercise 166Poor dietlack of exercise 166

Alcohol use 35Alcohol use 35

Infectious agents 31Infectious agents 31

Pollutantstoxins 23Pollutantstoxins 23

Motor vehicle crashes 18Motor vehicle crashes 18

Firearms 12Firearms 12

Risky sexual behavior 08Risky sexual behavior 08

Illicit drug use 07Illicit drug use 07

JAMA 2004 291 1238-45

Poor environmental quality accounts Poor environmental quality accounts for 25 of all preventable world for 25 of all preventable world

illnessillness

WHO 1997

Environmental Illness a Environmental Illness a SnapshotSnapshot

Environmental illness Environmental illness in US childrenin US children

$55 billionyear$55 billionyear Lead poisoningLead poisoning

AsthmaAsthma

CancerCancer

Developmental DisabilitiesDevelopmental Disabilities

EHP 2002 110 (7) 721-728

Healthy People 2010Healthy People 2010

National objectivesNational objectives Most significant Most significant

preventable preventable threats to health threats to health amp goals to reduce amp goals to reduce themthem

Includes Includes environmental environmental health objectiveshealth objectives

Providers role in Providers role in preventionprevention

Healthy People 2010 Toxic Healthy People 2010 Toxic WastesWastes

Lower elevated blood lead levels to Lower elevated blood lead levels to 11

Minimize risks from hazardous sitesMinimize risks from hazardous sites Reduce pesticide exposuresReduce pesticide exposures Reduce toxic pollutants produced Reduce toxic pollutants produced

disposed of treated or used for disposed of treated or used for energy recoveryenergy recovery

Increase recycling of solid waste to Increase recycling of solid waste to 3838

State of Knowledge Our State of Knowledge Our Chemical EnvironmentChemical Environment

gt80000 chemicals in gt80000 chemicals in Federal inventoryFederal inventory

2000 to 3000 NEW 2000 to 3000 NEW chemicals per yearchemicals per year

gt4 billion lbs released gt4 billion lbs released into environment yearly into environment yearly 72 million lbs of 72 million lbs of recognized carcinogens recognized carcinogens

Basic Screening Basic Screening Information Data Set Information Data Set (SIDS) avg $205000 per (SIDS) avg $205000 per chemicalchemical

Hazard Data - Chemicals Hazard Data - Chemicals Produced Produced

gt 1 Million PoundsYear gt 1 Million PoundsYear

0 10 20 30 40 50 60 70 80 90 100

Percentage Tested

Acute Toxicity

Environmental Fate

Ecotoxicity

Mutagenicity

Chronic Toxicity

ReproductiveToxicity

Full Set of BasicToxicity Tests

Medical WasteMedical Waste

6000 US hospitals~2 million 6000 US hospitals~2 million tons waste per year tons waste per year

Clinics and doctorsrsquo offices add 700000 Clinics and doctorsrsquo offices add 700000 tonstons

EPA regulations weak-HCWHh2eEPA regulations weak-HCWHh2e 850000 tons incinerated850000 tons incinerated

Pollutants inc dioxin Hg cadmium Pollutants inc dioxin Hg cadmium and Pband Pb

Segregation amp alternatives to Segregation amp alternatives to incineration incineration would cost 93 would cost 93 centspatientdaycentspatientday

Our Chemical EnvironmentOur Chemical Environment

1305 Superfund sites1305 Superfund sites 25002500 are are eligible eligible gt80kgt80k hazardous sites hazardous sites knownknown

~11 million people live within 1 mile~11 million people live within 1 mile ~25 live within 4 miles~25 live within 4 miles OR ranks 24OR ranks 24-12 Superfund sites-12 Superfund sites 3 in PDX3 in PDX Harbor Oil Portland Harbor Oil Portland

Harbor Harbor McCormick amp Baxter McCormick amp Baxter Creosoting Co Creosoting Co

Multnomah amp Washington CoMultnomah amp Washington CoShared Pollutants 2002Shared Pollutants 2002

Links to Disease Links to Disease

Methanol (gt240k lbs)Methanol (gt240k lbs)

StrongStrong ATN amp vision problems ATN amp vision problems

GoodGood Pancreatitis amp Pancreatitis amp Parkinsonrsquosmovement disorders Parkinsonrsquosmovement disorders

Ammonia (gt100k lbs)Ammonia (gt100k lbs)

StrongStrong Asthma acutechronic bronchitis Asthma acutechronic bronchitis olfactory disorders amp rhinitis olfactory disorders amp rhinitis

GoodGood Pulmonary edema Pulmonary edema

Links to Disease contLinks to Disease cont

Xylene (gt95k lbs) amp Toluene (gt83k lbs)Xylene (gt95k lbs) amp Toluene (gt83k lbs) GoodGood Scleroderma arrhythmias menstrual Scleroderma arrhythmias menstrual

do cognitive impairment hearing loss amp do cognitive impairment hearing loss amp fetal death (miscarriagestillbirth)fetal death (miscarriagestillbirth)

Glycol Ethers (gt20k lbs)Glycol Ethers (gt20k lbs) StrongStrong Reduced male fertility abnormal Reduced male fertility abnormal

sperm (morphology motility amp count) amp fetal sperm (morphology motility amp count) amp fetal death (miscarriagestillbirth) death (miscarriagestillbirth)

GoodGood ATN reduced female fertility general ATN reduced female fertility general congenital and craniofacial malformationscongenital and craniofacial malformations

National Report on Human National Report on Human Exposure to Environmental Exposure to Environmental

Chemicals Chemicals (CDC 705)(CDC 705)

Random selection from NHANES Random selection from NHANES surveysurvey

148 chemicals from 2001-2002 inc 148 chemicals from 2001-2002 inc data on 116 chemicals from 1999-data on 116 chemicals from 1999-20002000

Criteria for chemical inclusion Criteria for chemical inclusion wide exposure wide exposure serious health effects serious health effects adequate blood amp urine samples adequate blood amp urine samples efficacy of attempts to reduce efficacy of attempts to reduce

exposure exposure availability of reliable bio-monitoring availability of reliable bio-monitoring

methodmethod

CDC Report GoalsCDC Report Goals

Which chemicals are present amp Which chemicals are present amp concentrations concentrations

How many people have levels above How many people have levels above known toxicity thresholdsknown toxicity thresholds

Establish reference ranges Establish reference ranges Determine if levels are higher in at Determine if levels are higher in at

risk populations risk populations Track trends over time Track trends over time Set priorities for researchSet priorities for research

CDC Report HighlightsCDC Report Highlights

First time data for 38148 chemicalsFirst time data for 38148 chemicals BLL declining 44 of children early BLL declining 44 of children early

1990s 16 of children from 1999-1990s 16 of children from 1999-20022002

Hg in women of childbearing age Hg in women of childbearing age 57 have concerning levels57 have concerning levels

Pyrethroid insecticides (common Pyrethroid insecticides (common home use) 76 of populationhome use) 76 of population

Highlights contHighlights cont

Levels of 3 toxic pesticides- Levels of 3 toxic pesticides- Aldrin Dieldrin amp Endrin-very low Aldrin Dieldrin amp Endrin-very low

29 Dioxin-like compounds levels are 29 Dioxin-like compounds levels are declining declining

Cadmium 5 population gt20yrs age Cadmium 5 population gt20yrs age levels near toxic limit (kidney dz low levels near toxic limit (kidney dz low BMD)BMD)

Phthalates widespread higher in Phthalates widespread higher in women amp childrenwomen amp children

Limitations of Current DataLimitations of Current Data

Exposure to chemical mixtures Exposure to chemical mixtures common-research more complexcommon-research more complex

Data available for only minority Data available for only minority single agentssingle agents

Epidemiological amp animal studies Epidemiological amp animal studies often only data availableoften only data available

Result links btw Chronic Diseases amp Result links btw Chronic Diseases amp low dose chronic complex exposures low dose chronic complex exposures hard to ldquoproverdquohard to ldquoproverdquo

PROVEN HARM

PARTIALLY PROVEN

NOT YET RECOGNIZED

FOREVER UNRECOGNIZED

THE TOXIC ICEBERG________________________________________

Oregoniansrsquo HealthOregoniansrsquo Health12 CHEMICALS OF KEY CONCERN12 CHEMICALS OF KEY CONCERN 1048698 1048698 acroleinacrolein 1048698 1048698 benzenebenzene 1048698 1048698 benzo(a)pyrenebenzo(a)pyrene 1048698 1048698 bisphenol-Abisphenol-A 1048698 1048698 brominated flame retardants (BFRs)brominated flame retardants (BFRs) 1048698 1048698 dieseldiesel 1048698 1048698 dioxindioxin 1048698 1048698 formaldehydeformaldehyde 1048698 1048698 leadlead 1048698 1048698 mercurymercury home amp garden pesticideshome amp garden pesticides 1048698 1048698 phthalatesphthalates

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

A 52 yr-old pt co increasing tremor A 52 yr-old pt co increasing tremor On PE the tremor is pill-rolling and On PE the tremor is pill-rolling and resolves with intention +Romberg resolves with intention +Romberg sign unstable tandem gaitsign unstable tandem gait

You make a preliminary diagnosis of You make a preliminary diagnosis of early Parkinsonrsquos diseaseearly Parkinsonrsquos disease

Wife mentions reading about Wife mentions reading about environmental links to PD pt is a environmental links to PD pt is a farmer and has used pesticides for farmer and has used pesticides for years Could this be related to his years Could this be related to his diseasedisease

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

Paraquat rotenone organophosphates Paraquat rotenone organophosphates dieldrin and fungicides maneb amp dieldrin and fungicides maneb amp mancozeb implicatedmancozeb implicated

MPTP a designer heroin-like drug MPTP a designer heroin-like drug causes Parkinsonian syndrome in causes Parkinsonian syndrome in addictsaddicts

Higher incidence in industrialized Higher incidence in industrialized countries greatest risk in rural countries greatest risk in rural areasfarms prolonged pesticide useareasfarms prolonged pesticide use

Case control studies herbicide or Case control studies herbicide or insecticide exposure 3-4x likelyinsecticide exposure 3-4x likely

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

2005 Brown T et al Meta-analysis 2005 Brown T et al Meta-analysis of epidemi-ologic amp toxicologic of epidemi-ologic amp toxicologic studies since 1983 studies since 1983

Verified most of these links noting Verified most of these links noting limitations in study designs limitations in study designs

Conclusion ldquogeneric association btw Conclusion ldquogeneric association btw pesticide exposure amp PD exists but pesticide exposure amp PD exists but is insufficient tohellipconcludehellipa causal is insufficient tohellipconcludehellipa causal relationshiprdquo relationshiprdquo

Pesticides Genes amp PDPesticides Genes amp PD

Dr W Langston of Parkinsonrsquos Dr W Langston of Parkinsonrsquos Institute ldquoAccelerating Research on Institute ldquoAccelerating Research on Genes and Environment in Genes and Environment in Parkinsonrsquos Diseaserdquo (2005)Parkinsonrsquos Diseaserdquo (2005)

Two PD studies underway one in Two PD studies underway one in pesticide applicators other in two pesticide applicators other in two CA counties with known heavy CA counties with known heavy exposureexposure

Other Health Impacts of Other Health Impacts of PesticidesPesticides

ArrhythmiasArrhythmiasAsthmaAsthmaLymphomas Brain tumorsLymphomas Brain tumorsAbnormal sperm countsAbnormal sperm countsBirth defects amp developmental delaysBirth defects amp developmental delaysHyperactivity amp behavioral problemsHyperactivity amp behavioral problemsDecreased endurance amp coordinationDecreased endurance amp coordinationNeurocognitive problemsNeurocognitive problemsPeripheral neuropathiesPeripheral neuropathies

Pesticides a Persistent Pesticides a Persistent ProblemProblem

Major classesMajor classes insecticides fungicides insecticides fungicides herbicides rodenticidesherbicides rodenticides

1997 Market1997 Market US $119 billion World $37 US $119 billion World $37 billionbillion

HistoryHistory synthetic-new to humans amp synthetic-new to humans amp environment since 1940s gt800 licensed environment since 1940s gt800 licensed ldquoactiverdquo ingredientsldquoactiverdquo ingredients

Manufacturers Manufacturers Bayer Aventis other drug Bayer Aventis other drug coco

Inherent toxicityInherent toxicity 140 pesticides considered 140 pesticides considered neurotoxic 37 are used on food ampor feedneurotoxic 37 are used on food ampor feed

Insecticide Sites of Insecticide Sites of ActionAction

Enzymes

Axonal Membranes

Ions (Na+ K+ Ca++ Cl-)

Enzymes

Neurotransmitters

Organochlorines

Pyrethroids

Casarett and Doullrsquos Toxicology The Basic Science of Poisons 5th Edition Ed Klaassen CD

McGraw-Hill New York 1996 P 649

Organophosphorus and

Carbamate Esters

Organophosphate PesticidesOrganophosphate PesticidesOccurrence and distribution in surface amp

ground water of the United States 1992-97

httpgawaterusgsgovpublicationsabstractsofr00-187html

Background Pesticide Background Pesticide Exposures WidespreadExposures Widespread

Reported useReported use 98 of families 80 during 98 of families 80 during pregnancypregnancy

In HumansIn Humans detectable chlorpyrifos detectable chlorpyrifos metabolites in 92 of childrenrsquos 82 of metabolites in 92 of childrenrsquos 82 of adultsrsquo urine samplesadultsrsquo urine samples

In FoodIn Food residues of at least one pesticide on residues of at least one pesticide on 72 fruits amp vegetables72 fruits amp vegetables

In HomesIn Homes 3 to 9 pesticide residues found3 to 9 pesticide residues found

In AirIn Air indoor levels 10-100X higher than indoor levels 10-100X higher than outdooroutdoor

In WaterIn Water gt90 stream samples 50 of gt90 stream samples 50 of wellswells

Sources of PesticidesSources of Pesticides

Household uses lawn amp garden Household uses lawn amp garden sprays exterminators flea collarssprays exterminators flea collars

Household dust (tracking in on shoes)Household dust (tracking in on shoes)

Public schools hospitals parks Public schools hospitals parks childcare facilitieschildcare facilities

Agricultural uses amp workersrsquo clothesAgricultural uses amp workersrsquo clothes

Non-organic foodsNon-organic foods

Breast milkBreast milk

Strategies to Reduces Strategies to Reduces Exposure to Home amp Garden Exposure to Home amp Garden

Pesticides in OregonPesticides in OregonPolicy SolutionsPolicy Solutions OR pesticide use reporting system OR pesticide use reporting system

(1999) finally funded 2005(1999) finally funded 2005 Educate homeowners re nontoxic Educate homeowners re nontoxic

options options Enc pet owners to use flea combs and Enc pet owners to use flea combs and

vacuuming to control fleasvacuuming to control fleas Enc public places to use Integrated Enc public places to use Integrated

Pest Management (IPM) ie Pesticide Pest Management (IPM) ie Pesticide Free ParksFree Parks

What YOU Can Do about What YOU Can Do about PesticidesPesticides

Advise PatientsAdvise Patients Regularly dustRegularly dust Use Integrated Pest Management Use Integrated Pest Management Cleanremove shoes outsideCleanremove shoes outside Keep contaminated clothes separateKeep contaminated clothes separate Buy sustainably grown foodBuy sustainably grown food Store food in secure nontoxic Store food in secure nontoxic

containerscontainers

Mercury amp Women of Mercury amp Women of Childbearing AgeChildbearing Age

A 32 yo G0P0 woman of A 32 yo G0P0 woman of childbearing age (WCBA) childbearing age (WCBA) presents for annual PE presents for annual PE

PMH negativePMH negative

Social hx husband is Social hx husband is recreational fisherman recreational fisherman

Contemplating pregnancy Contemplating pregnancy

Should she avoid fish Should she avoid fish because of mercury risks because of mercury risks to the fetusto the fetus

Mercury amp WCBAMercury amp WCBA

gt10gt10 of WCBA exceed safe limit of of WCBA exceed safe limit of 1ugkgday1ugkgday

5050 of women of women who eat fishwho eat fish exceed exceed limitlimit

5757 of WCBA have Hg levels of WCBA have Hg levels concerning for adverse effects concerning for adverse effects (CDC (CDC Natrsquol Report 0705Natrsquol Report 0705))

Higher risk Higher risk 300 000 childrenyear 300 000 childrenyear subsistence fishers immigrants subsistence fishers immigrants Native AmericansNative Americans

Mercury amp WCBAMercury amp WCBA

Hg enters tissues variable excretionHg enters tissues variable excretion Breast Milk PCBs DDT amp other Breast Milk PCBs DDT amp other

pesticides dioxins dibenzofurans pesticides dioxins dibenzofurans toxic flame retardants amp heavy toxic flame retardants amp heavy metals (Pb amp Hg) metals (Pb amp Hg)

No bio-accumulation in milk but No bio-accumulation in milk but levels in fish-eaters may exceed levels in fish-eaters may exceed unexposed women by 100x unexposed women by 100x

Scientific evidence indicates Scientific evidence indicates advantages of breast-feeding advantages of breast-feeding outweigh riskshellipoutweigh riskshellip

Neuro Effects of MercuryNeuro Effects of Mercury

Cerebral palsyCerebral palsy MRDDMRDD disequilibrium ataxiadisequilibrium ataxia hearing lossdeafnesshearing lossdeafness visual visual

impairmentblindnessimpairmentblindness peripheral neuropathyperipheral neuropathy parasthesiasparasthesias tremors seizures tremors seizures abnl reflexes amp muscle toneabnl reflexes amp muscle tone Psychiatric disturbances Psychiatric disturbances

Mercury a Persistent Mercury a Persistent ProblemProblem

PoisoningsPoisonings Minamata 1950s amp Iraq Minamata 1950s amp Iraq 19711971

Nationally ~Nationally ~160 tons of Hg annually160 tons of Hg annually In OregonIn Oregon ~ ~4500 lbs annually4500 lbs annually Lack of regulationLack of regulation In OR 10 facilities In OR 10 facilities

report Hg release-none has a permit or is report Hg release-none has a permit or is required to monitor emissions by staterequired to monitor emissions by state

Fish AdvisoriesFish Advisories in 2004 45 states had in 2004 45 states had gt2000 warnings Oregon lists advisories gt2000 warnings Oregon lists advisories for 12 water bodies inc Willamette for 12 water bodies inc Willamette

Atmospheric HgAtmospheric Hg

The Mercury CycleThe Mercury Cycle

MercuryMercuryDeclining Threshold of Declining Threshold of

HarmHarm

2000199019801970001

01

1

10

100

YEAR

Level associated with harmful effectRegulatory standard (maximum safe exposure or high end exposure from allowed fish contamination)

FDA WHO

EPA

ATSDR

DA

ILY

IN

TA

KE

(mic

rogr

ams

kg

day

Hg)

Sources of MercurySources of MercuryIndustrial emissions Industrial emissions

coal fired plantscoal fired plantsMunicipal amp medical Municipal amp medical

waste incineratorswaste incineratorsAbandoned Hg amp gold Abandoned Hg amp gold

minesminesNatural off-gassing Natural off-gassing Dental amalgamsDental amalgamsBioaccumulation in Bioaccumulation in

foods esp fishfoods esp fishOld thermometers BP Old thermometers BP

cuffs amp auto cuffs amp auto switchesswitches

Strategies to Reduce Strategies to Reduce Mercury Pollution in Mercury Pollution in

OregonOregonPolicy SolutionsPolicy Solutions Mercury Solutions Act of 2001Mercury Solutions Act of 2001 Ensure safe collection amp recyclingEnsure safe collection amp recycling Clean up abandoned mines and Clean up abandoned mines and

SuperfundsSuperfunds Reduce Hg emissions from health Reduce Hg emissions from health

care facilitiescare facilities Inc Hg in applicable DEQ air amp Inc Hg in applicable DEQ air amp

water permitswater permits Coal burning power plant Boardman Coal burning power plant Boardman

OR OR Implement OR Executive OrderImplement OR Executive Order

What YOU Can Do about What YOU Can Do about MercuryMercury

Advise PatientsAdvise Patients Provide Provide An Expectant Motherrsquos Guide to An Expectant Motherrsquos Guide to

Eating Fish in Oregon (DHS) Eating Fish in Oregon (DHS) in waiting in waiting roomsrooms

Rec WCBA and children avoid fish wHgRec WCBA and children avoid fish wHg Enc WCBA to consume low-fat dietEnc WCBA to consume low-fat diet Recycle old Hg thermometers Recycle old Hg thermometers

thermostats amp fluorescent light tubesthermostats amp fluorescent light tubes Have car checked for Hg switches at Have car checked for Hg switches at

participating auto shop (free participating auto shop (free replacement)replacement)

Use digital thermometers amp thermostatsUse digital thermometers amp thermostats

SummarySummary Chronic Diseases are prevalent Toxic Chronic Diseases are prevalent Toxic

exposures are possible exposures are possible preventablepreventable contributorscontributors

Pesticides amp risk of Parkinsonrsquos and Mercury Pesticides amp risk of Parkinsonrsquos and Mercury risks to WCBA are more understood than most risks to WCBA are more understood than most toxins and other chronic diseasestoxins and other chronic diseases

Apparent toxicity at high doses should be a Apparent toxicity at high doses should be a red flag for possible harm from low dose red flag for possible harm from low dose chronic exposureschronic exposures

Since ldquoproofrdquo of harm materializes slowly Since ldquoproofrdquo of harm materializes slowly generations are at risk and may be harmed generations are at risk and may be harmed before adequate regulatory response occursbefore adequate regulatory response occurs

Kaiser amp HCWHh2eKaiser amp HCWHh2e

Clean Diesel Hospital Zones ProjectClean Diesel Hospital Zones Project Healthy Food in Healthcare InitiativeHealthy Food in Healthcare Initiative Green Building PVC and DEHP free Green Building PVC and DEHP free

NICU NICU Environmentally preferable purchasing Environmentally preferable purchasing

policypolicy Making Medicine Mercury Free Award Making Medicine Mercury Free Award h2e Environmental Leadership Award h2e Environmental Leadership Award

20022002

What Can You DoWhat Can You Do

Be aware of environmental toxins amp Be aware of environmental toxins amp their possible links to chronic diseasestheir possible links to chronic diseases

Provide advice amp education on Provide advice amp education on prevention andor minimizing prevention andor minimizing exposures or refer appropriately exposures or refer appropriately

Incorporate environmental questions Incorporate environmental questions into clinical historyinto clinical history

Advocate Advocate wwwenvirohealthactionorgwwwenvirohealthactionorg

Local AdvocacyLocal Advocacy Oregon Environmental CouncilOregon Environmental Council wwwoeconlineorgwwwoeconlineorg Oregon Collaborative on Health amp Oregon Collaborative on Health amp

EnvironmentEnvironment Healthy Environment ForumsHealthy Environment Forums Oregon Center for Environmental HealthOregon Center for Environmental Health wwworegon-healthorgwwworegon-healthorg Healthcare without HarmHealthcare without Harm Hospitals for Healthy Environment (h2e)Hospitals for Healthy Environment (h2e) Oregon PSROregon PSR wwworegonpsrorgwwworegonpsrorg Environmental Health-In Harmrsquos Way Environmental Health-In Harmrsquos Way

Chronic Disease a Chronic Disease a SnapshotSnapshot

1 overall killer in US (7 of 10 deaths 1 overall killer in US (7 of 10 deaths per year)per year)

~90-100 million Americans (13 of ~90-100 million Americans (13 of population) population)

gt75 of US $14 trillion medical care gt75 of US $14 trillion medical care costs costs

Account for 13 of the years of potential Account for 13 of the years of potential life lost before age 65 life lost before age 65

Modifiable Risk Factors amp Modifiable Risk Factors amp Death Death

United States 2000United States 2000Percentage of all deathsPercentage of all deathsTobacco use 181Tobacco use 181

Poor dietlack of exercise 166Poor dietlack of exercise 166

Alcohol use 35Alcohol use 35

Infectious agents 31Infectious agents 31

Pollutantstoxins 23Pollutantstoxins 23

Motor vehicle crashes 18Motor vehicle crashes 18

Firearms 12Firearms 12

Risky sexual behavior 08Risky sexual behavior 08

Illicit drug use 07Illicit drug use 07

JAMA 2004 291 1238-45

Poor environmental quality accounts Poor environmental quality accounts for 25 of all preventable world for 25 of all preventable world

illnessillness

WHO 1997

Environmental Illness a Environmental Illness a SnapshotSnapshot

Environmental illness Environmental illness in US childrenin US children

$55 billionyear$55 billionyear Lead poisoningLead poisoning

AsthmaAsthma

CancerCancer

Developmental DisabilitiesDevelopmental Disabilities

EHP 2002 110 (7) 721-728

Healthy People 2010Healthy People 2010

National objectivesNational objectives Most significant Most significant

preventable preventable threats to health threats to health amp goals to reduce amp goals to reduce themthem

Includes Includes environmental environmental health objectiveshealth objectives

Providers role in Providers role in preventionprevention

Healthy People 2010 Toxic Healthy People 2010 Toxic WastesWastes

Lower elevated blood lead levels to Lower elevated blood lead levels to 11

Minimize risks from hazardous sitesMinimize risks from hazardous sites Reduce pesticide exposuresReduce pesticide exposures Reduce toxic pollutants produced Reduce toxic pollutants produced

disposed of treated or used for disposed of treated or used for energy recoveryenergy recovery

Increase recycling of solid waste to Increase recycling of solid waste to 3838

State of Knowledge Our State of Knowledge Our Chemical EnvironmentChemical Environment

gt80000 chemicals in gt80000 chemicals in Federal inventoryFederal inventory

2000 to 3000 NEW 2000 to 3000 NEW chemicals per yearchemicals per year

gt4 billion lbs released gt4 billion lbs released into environment yearly into environment yearly 72 million lbs of 72 million lbs of recognized carcinogens recognized carcinogens

Basic Screening Basic Screening Information Data Set Information Data Set (SIDS) avg $205000 per (SIDS) avg $205000 per chemicalchemical

Hazard Data - Chemicals Hazard Data - Chemicals Produced Produced

gt 1 Million PoundsYear gt 1 Million PoundsYear

0 10 20 30 40 50 60 70 80 90 100

Percentage Tested

Acute Toxicity

Environmental Fate

Ecotoxicity

Mutagenicity

Chronic Toxicity

ReproductiveToxicity

Full Set of BasicToxicity Tests

Medical WasteMedical Waste

6000 US hospitals~2 million 6000 US hospitals~2 million tons waste per year tons waste per year

Clinics and doctorsrsquo offices add 700000 Clinics and doctorsrsquo offices add 700000 tonstons

EPA regulations weak-HCWHh2eEPA regulations weak-HCWHh2e 850000 tons incinerated850000 tons incinerated

Pollutants inc dioxin Hg cadmium Pollutants inc dioxin Hg cadmium and Pband Pb

Segregation amp alternatives to Segregation amp alternatives to incineration incineration would cost 93 would cost 93 centspatientdaycentspatientday

Our Chemical EnvironmentOur Chemical Environment

1305 Superfund sites1305 Superfund sites 25002500 are are eligible eligible gt80kgt80k hazardous sites hazardous sites knownknown

~11 million people live within 1 mile~11 million people live within 1 mile ~25 live within 4 miles~25 live within 4 miles OR ranks 24OR ranks 24-12 Superfund sites-12 Superfund sites 3 in PDX3 in PDX Harbor Oil Portland Harbor Oil Portland

Harbor Harbor McCormick amp Baxter McCormick amp Baxter Creosoting Co Creosoting Co

Multnomah amp Washington CoMultnomah amp Washington CoShared Pollutants 2002Shared Pollutants 2002

Links to Disease Links to Disease

Methanol (gt240k lbs)Methanol (gt240k lbs)

StrongStrong ATN amp vision problems ATN amp vision problems

GoodGood Pancreatitis amp Pancreatitis amp Parkinsonrsquosmovement disorders Parkinsonrsquosmovement disorders

Ammonia (gt100k lbs)Ammonia (gt100k lbs)

StrongStrong Asthma acutechronic bronchitis Asthma acutechronic bronchitis olfactory disorders amp rhinitis olfactory disorders amp rhinitis

GoodGood Pulmonary edema Pulmonary edema

Links to Disease contLinks to Disease cont

Xylene (gt95k lbs) amp Toluene (gt83k lbs)Xylene (gt95k lbs) amp Toluene (gt83k lbs) GoodGood Scleroderma arrhythmias menstrual Scleroderma arrhythmias menstrual

do cognitive impairment hearing loss amp do cognitive impairment hearing loss amp fetal death (miscarriagestillbirth)fetal death (miscarriagestillbirth)

Glycol Ethers (gt20k lbs)Glycol Ethers (gt20k lbs) StrongStrong Reduced male fertility abnormal Reduced male fertility abnormal

sperm (morphology motility amp count) amp fetal sperm (morphology motility amp count) amp fetal death (miscarriagestillbirth) death (miscarriagestillbirth)

GoodGood ATN reduced female fertility general ATN reduced female fertility general congenital and craniofacial malformationscongenital and craniofacial malformations

National Report on Human National Report on Human Exposure to Environmental Exposure to Environmental

Chemicals Chemicals (CDC 705)(CDC 705)

Random selection from NHANES Random selection from NHANES surveysurvey

148 chemicals from 2001-2002 inc 148 chemicals from 2001-2002 inc data on 116 chemicals from 1999-data on 116 chemicals from 1999-20002000

Criteria for chemical inclusion Criteria for chemical inclusion wide exposure wide exposure serious health effects serious health effects adequate blood amp urine samples adequate blood amp urine samples efficacy of attempts to reduce efficacy of attempts to reduce

exposure exposure availability of reliable bio-monitoring availability of reliable bio-monitoring

methodmethod

CDC Report GoalsCDC Report Goals

Which chemicals are present amp Which chemicals are present amp concentrations concentrations

How many people have levels above How many people have levels above known toxicity thresholdsknown toxicity thresholds

Establish reference ranges Establish reference ranges Determine if levels are higher in at Determine if levels are higher in at

risk populations risk populations Track trends over time Track trends over time Set priorities for researchSet priorities for research

CDC Report HighlightsCDC Report Highlights

First time data for 38148 chemicalsFirst time data for 38148 chemicals BLL declining 44 of children early BLL declining 44 of children early

1990s 16 of children from 1999-1990s 16 of children from 1999-20022002

Hg in women of childbearing age Hg in women of childbearing age 57 have concerning levels57 have concerning levels

Pyrethroid insecticides (common Pyrethroid insecticides (common home use) 76 of populationhome use) 76 of population

Highlights contHighlights cont

Levels of 3 toxic pesticides- Levels of 3 toxic pesticides- Aldrin Dieldrin amp Endrin-very low Aldrin Dieldrin amp Endrin-very low

29 Dioxin-like compounds levels are 29 Dioxin-like compounds levels are declining declining

Cadmium 5 population gt20yrs age Cadmium 5 population gt20yrs age levels near toxic limit (kidney dz low levels near toxic limit (kidney dz low BMD)BMD)

Phthalates widespread higher in Phthalates widespread higher in women amp childrenwomen amp children

Limitations of Current DataLimitations of Current Data

Exposure to chemical mixtures Exposure to chemical mixtures common-research more complexcommon-research more complex

Data available for only minority Data available for only minority single agentssingle agents

Epidemiological amp animal studies Epidemiological amp animal studies often only data availableoften only data available

Result links btw Chronic Diseases amp Result links btw Chronic Diseases amp low dose chronic complex exposures low dose chronic complex exposures hard to ldquoproverdquohard to ldquoproverdquo

PROVEN HARM

PARTIALLY PROVEN

NOT YET RECOGNIZED

FOREVER UNRECOGNIZED

THE TOXIC ICEBERG________________________________________

Oregoniansrsquo HealthOregoniansrsquo Health12 CHEMICALS OF KEY CONCERN12 CHEMICALS OF KEY CONCERN 1048698 1048698 acroleinacrolein 1048698 1048698 benzenebenzene 1048698 1048698 benzo(a)pyrenebenzo(a)pyrene 1048698 1048698 bisphenol-Abisphenol-A 1048698 1048698 brominated flame retardants (BFRs)brominated flame retardants (BFRs) 1048698 1048698 dieseldiesel 1048698 1048698 dioxindioxin 1048698 1048698 formaldehydeformaldehyde 1048698 1048698 leadlead 1048698 1048698 mercurymercury home amp garden pesticideshome amp garden pesticides 1048698 1048698 phthalatesphthalates

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

A 52 yr-old pt co increasing tremor A 52 yr-old pt co increasing tremor On PE the tremor is pill-rolling and On PE the tremor is pill-rolling and resolves with intention +Romberg resolves with intention +Romberg sign unstable tandem gaitsign unstable tandem gait

You make a preliminary diagnosis of You make a preliminary diagnosis of early Parkinsonrsquos diseaseearly Parkinsonrsquos disease

Wife mentions reading about Wife mentions reading about environmental links to PD pt is a environmental links to PD pt is a farmer and has used pesticides for farmer and has used pesticides for years Could this be related to his years Could this be related to his diseasedisease

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

Paraquat rotenone organophosphates Paraquat rotenone organophosphates dieldrin and fungicides maneb amp dieldrin and fungicides maneb amp mancozeb implicatedmancozeb implicated

MPTP a designer heroin-like drug MPTP a designer heroin-like drug causes Parkinsonian syndrome in causes Parkinsonian syndrome in addictsaddicts

Higher incidence in industrialized Higher incidence in industrialized countries greatest risk in rural countries greatest risk in rural areasfarms prolonged pesticide useareasfarms prolonged pesticide use

Case control studies herbicide or Case control studies herbicide or insecticide exposure 3-4x likelyinsecticide exposure 3-4x likely

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

2005 Brown T et al Meta-analysis 2005 Brown T et al Meta-analysis of epidemi-ologic amp toxicologic of epidemi-ologic amp toxicologic studies since 1983 studies since 1983

Verified most of these links noting Verified most of these links noting limitations in study designs limitations in study designs

Conclusion ldquogeneric association btw Conclusion ldquogeneric association btw pesticide exposure amp PD exists but pesticide exposure amp PD exists but is insufficient tohellipconcludehellipa causal is insufficient tohellipconcludehellipa causal relationshiprdquo relationshiprdquo

Pesticides Genes amp PDPesticides Genes amp PD

Dr W Langston of Parkinsonrsquos Dr W Langston of Parkinsonrsquos Institute ldquoAccelerating Research on Institute ldquoAccelerating Research on Genes and Environment in Genes and Environment in Parkinsonrsquos Diseaserdquo (2005)Parkinsonrsquos Diseaserdquo (2005)

Two PD studies underway one in Two PD studies underway one in pesticide applicators other in two pesticide applicators other in two CA counties with known heavy CA counties with known heavy exposureexposure

Other Health Impacts of Other Health Impacts of PesticidesPesticides

ArrhythmiasArrhythmiasAsthmaAsthmaLymphomas Brain tumorsLymphomas Brain tumorsAbnormal sperm countsAbnormal sperm countsBirth defects amp developmental delaysBirth defects amp developmental delaysHyperactivity amp behavioral problemsHyperactivity amp behavioral problemsDecreased endurance amp coordinationDecreased endurance amp coordinationNeurocognitive problemsNeurocognitive problemsPeripheral neuropathiesPeripheral neuropathies

Pesticides a Persistent Pesticides a Persistent ProblemProblem

Major classesMajor classes insecticides fungicides insecticides fungicides herbicides rodenticidesherbicides rodenticides

1997 Market1997 Market US $119 billion World $37 US $119 billion World $37 billionbillion

HistoryHistory synthetic-new to humans amp synthetic-new to humans amp environment since 1940s gt800 licensed environment since 1940s gt800 licensed ldquoactiverdquo ingredientsldquoactiverdquo ingredients

Manufacturers Manufacturers Bayer Aventis other drug Bayer Aventis other drug coco

Inherent toxicityInherent toxicity 140 pesticides considered 140 pesticides considered neurotoxic 37 are used on food ampor feedneurotoxic 37 are used on food ampor feed

Insecticide Sites of Insecticide Sites of ActionAction

Enzymes

Axonal Membranes

Ions (Na+ K+ Ca++ Cl-)

Enzymes

Neurotransmitters

Organochlorines

Pyrethroids

Casarett and Doullrsquos Toxicology The Basic Science of Poisons 5th Edition Ed Klaassen CD

McGraw-Hill New York 1996 P 649

Organophosphorus and

Carbamate Esters

Organophosphate PesticidesOrganophosphate PesticidesOccurrence and distribution in surface amp

ground water of the United States 1992-97

httpgawaterusgsgovpublicationsabstractsofr00-187html

Background Pesticide Background Pesticide Exposures WidespreadExposures Widespread

Reported useReported use 98 of families 80 during 98 of families 80 during pregnancypregnancy

In HumansIn Humans detectable chlorpyrifos detectable chlorpyrifos metabolites in 92 of childrenrsquos 82 of metabolites in 92 of childrenrsquos 82 of adultsrsquo urine samplesadultsrsquo urine samples

In FoodIn Food residues of at least one pesticide on residues of at least one pesticide on 72 fruits amp vegetables72 fruits amp vegetables

In HomesIn Homes 3 to 9 pesticide residues found3 to 9 pesticide residues found

In AirIn Air indoor levels 10-100X higher than indoor levels 10-100X higher than outdooroutdoor

In WaterIn Water gt90 stream samples 50 of gt90 stream samples 50 of wellswells

Sources of PesticidesSources of Pesticides

Household uses lawn amp garden Household uses lawn amp garden sprays exterminators flea collarssprays exterminators flea collars

Household dust (tracking in on shoes)Household dust (tracking in on shoes)

Public schools hospitals parks Public schools hospitals parks childcare facilitieschildcare facilities

Agricultural uses amp workersrsquo clothesAgricultural uses amp workersrsquo clothes

Non-organic foodsNon-organic foods

Breast milkBreast milk

Strategies to Reduces Strategies to Reduces Exposure to Home amp Garden Exposure to Home amp Garden

Pesticides in OregonPesticides in OregonPolicy SolutionsPolicy Solutions OR pesticide use reporting system OR pesticide use reporting system

(1999) finally funded 2005(1999) finally funded 2005 Educate homeowners re nontoxic Educate homeowners re nontoxic

options options Enc pet owners to use flea combs and Enc pet owners to use flea combs and

vacuuming to control fleasvacuuming to control fleas Enc public places to use Integrated Enc public places to use Integrated

Pest Management (IPM) ie Pesticide Pest Management (IPM) ie Pesticide Free ParksFree Parks

What YOU Can Do about What YOU Can Do about PesticidesPesticides

Advise PatientsAdvise Patients Regularly dustRegularly dust Use Integrated Pest Management Use Integrated Pest Management Cleanremove shoes outsideCleanremove shoes outside Keep contaminated clothes separateKeep contaminated clothes separate Buy sustainably grown foodBuy sustainably grown food Store food in secure nontoxic Store food in secure nontoxic

containerscontainers

Mercury amp Women of Mercury amp Women of Childbearing AgeChildbearing Age

A 32 yo G0P0 woman of A 32 yo G0P0 woman of childbearing age (WCBA) childbearing age (WCBA) presents for annual PE presents for annual PE

PMH negativePMH negative

Social hx husband is Social hx husband is recreational fisherman recreational fisherman

Contemplating pregnancy Contemplating pregnancy

Should she avoid fish Should she avoid fish because of mercury risks because of mercury risks to the fetusto the fetus

Mercury amp WCBAMercury amp WCBA

gt10gt10 of WCBA exceed safe limit of of WCBA exceed safe limit of 1ugkgday1ugkgday

5050 of women of women who eat fishwho eat fish exceed exceed limitlimit

5757 of WCBA have Hg levels of WCBA have Hg levels concerning for adverse effects concerning for adverse effects (CDC (CDC Natrsquol Report 0705Natrsquol Report 0705))

Higher risk Higher risk 300 000 childrenyear 300 000 childrenyear subsistence fishers immigrants subsistence fishers immigrants Native AmericansNative Americans

Mercury amp WCBAMercury amp WCBA

Hg enters tissues variable excretionHg enters tissues variable excretion Breast Milk PCBs DDT amp other Breast Milk PCBs DDT amp other

pesticides dioxins dibenzofurans pesticides dioxins dibenzofurans toxic flame retardants amp heavy toxic flame retardants amp heavy metals (Pb amp Hg) metals (Pb amp Hg)

No bio-accumulation in milk but No bio-accumulation in milk but levels in fish-eaters may exceed levels in fish-eaters may exceed unexposed women by 100x unexposed women by 100x

Scientific evidence indicates Scientific evidence indicates advantages of breast-feeding advantages of breast-feeding outweigh riskshellipoutweigh riskshellip

Neuro Effects of MercuryNeuro Effects of Mercury

Cerebral palsyCerebral palsy MRDDMRDD disequilibrium ataxiadisequilibrium ataxia hearing lossdeafnesshearing lossdeafness visual visual

impairmentblindnessimpairmentblindness peripheral neuropathyperipheral neuropathy parasthesiasparasthesias tremors seizures tremors seizures abnl reflexes amp muscle toneabnl reflexes amp muscle tone Psychiatric disturbances Psychiatric disturbances

Mercury a Persistent Mercury a Persistent ProblemProblem

PoisoningsPoisonings Minamata 1950s amp Iraq Minamata 1950s amp Iraq 19711971

Nationally ~Nationally ~160 tons of Hg annually160 tons of Hg annually In OregonIn Oregon ~ ~4500 lbs annually4500 lbs annually Lack of regulationLack of regulation In OR 10 facilities In OR 10 facilities

report Hg release-none has a permit or is report Hg release-none has a permit or is required to monitor emissions by staterequired to monitor emissions by state

Fish AdvisoriesFish Advisories in 2004 45 states had in 2004 45 states had gt2000 warnings Oregon lists advisories gt2000 warnings Oregon lists advisories for 12 water bodies inc Willamette for 12 water bodies inc Willamette

Atmospheric HgAtmospheric Hg

The Mercury CycleThe Mercury Cycle

MercuryMercuryDeclining Threshold of Declining Threshold of

HarmHarm

2000199019801970001

01

1

10

100

YEAR

Level associated with harmful effectRegulatory standard (maximum safe exposure or high end exposure from allowed fish contamination)

FDA WHO

EPA

ATSDR

DA

ILY

IN

TA

KE

(mic

rogr

ams

kg

day

Hg)

Sources of MercurySources of MercuryIndustrial emissions Industrial emissions

coal fired plantscoal fired plantsMunicipal amp medical Municipal amp medical

waste incineratorswaste incineratorsAbandoned Hg amp gold Abandoned Hg amp gold

minesminesNatural off-gassing Natural off-gassing Dental amalgamsDental amalgamsBioaccumulation in Bioaccumulation in

foods esp fishfoods esp fishOld thermometers BP Old thermometers BP

cuffs amp auto cuffs amp auto switchesswitches

Strategies to Reduce Strategies to Reduce Mercury Pollution in Mercury Pollution in

OregonOregonPolicy SolutionsPolicy Solutions Mercury Solutions Act of 2001Mercury Solutions Act of 2001 Ensure safe collection amp recyclingEnsure safe collection amp recycling Clean up abandoned mines and Clean up abandoned mines and

SuperfundsSuperfunds Reduce Hg emissions from health Reduce Hg emissions from health

care facilitiescare facilities Inc Hg in applicable DEQ air amp Inc Hg in applicable DEQ air amp

water permitswater permits Coal burning power plant Boardman Coal burning power plant Boardman

OR OR Implement OR Executive OrderImplement OR Executive Order

What YOU Can Do about What YOU Can Do about MercuryMercury

Advise PatientsAdvise Patients Provide Provide An Expectant Motherrsquos Guide to An Expectant Motherrsquos Guide to

Eating Fish in Oregon (DHS) Eating Fish in Oregon (DHS) in waiting in waiting roomsrooms

Rec WCBA and children avoid fish wHgRec WCBA and children avoid fish wHg Enc WCBA to consume low-fat dietEnc WCBA to consume low-fat diet Recycle old Hg thermometers Recycle old Hg thermometers

thermostats amp fluorescent light tubesthermostats amp fluorescent light tubes Have car checked for Hg switches at Have car checked for Hg switches at

participating auto shop (free participating auto shop (free replacement)replacement)

Use digital thermometers amp thermostatsUse digital thermometers amp thermostats

SummarySummary Chronic Diseases are prevalent Toxic Chronic Diseases are prevalent Toxic

exposures are possible exposures are possible preventablepreventable contributorscontributors

Pesticides amp risk of Parkinsonrsquos and Mercury Pesticides amp risk of Parkinsonrsquos and Mercury risks to WCBA are more understood than most risks to WCBA are more understood than most toxins and other chronic diseasestoxins and other chronic diseases

Apparent toxicity at high doses should be a Apparent toxicity at high doses should be a red flag for possible harm from low dose red flag for possible harm from low dose chronic exposureschronic exposures

Since ldquoproofrdquo of harm materializes slowly Since ldquoproofrdquo of harm materializes slowly generations are at risk and may be harmed generations are at risk and may be harmed before adequate regulatory response occursbefore adequate regulatory response occurs

Kaiser amp HCWHh2eKaiser amp HCWHh2e

Clean Diesel Hospital Zones ProjectClean Diesel Hospital Zones Project Healthy Food in Healthcare InitiativeHealthy Food in Healthcare Initiative Green Building PVC and DEHP free Green Building PVC and DEHP free

NICU NICU Environmentally preferable purchasing Environmentally preferable purchasing

policypolicy Making Medicine Mercury Free Award Making Medicine Mercury Free Award h2e Environmental Leadership Award h2e Environmental Leadership Award

20022002

What Can You DoWhat Can You Do

Be aware of environmental toxins amp Be aware of environmental toxins amp their possible links to chronic diseasestheir possible links to chronic diseases

Provide advice amp education on Provide advice amp education on prevention andor minimizing prevention andor minimizing exposures or refer appropriately exposures or refer appropriately

Incorporate environmental questions Incorporate environmental questions into clinical historyinto clinical history

Advocate Advocate wwwenvirohealthactionorgwwwenvirohealthactionorg

Local AdvocacyLocal Advocacy Oregon Environmental CouncilOregon Environmental Council wwwoeconlineorgwwwoeconlineorg Oregon Collaborative on Health amp Oregon Collaborative on Health amp

EnvironmentEnvironment Healthy Environment ForumsHealthy Environment Forums Oregon Center for Environmental HealthOregon Center for Environmental Health wwworegon-healthorgwwworegon-healthorg Healthcare without HarmHealthcare without Harm Hospitals for Healthy Environment (h2e)Hospitals for Healthy Environment (h2e) Oregon PSROregon PSR wwworegonpsrorgwwworegonpsrorg Environmental Health-In Harmrsquos Way Environmental Health-In Harmrsquos Way

Modifiable Risk Factors amp Modifiable Risk Factors amp Death Death

United States 2000United States 2000Percentage of all deathsPercentage of all deathsTobacco use 181Tobacco use 181

Poor dietlack of exercise 166Poor dietlack of exercise 166

Alcohol use 35Alcohol use 35

Infectious agents 31Infectious agents 31

Pollutantstoxins 23Pollutantstoxins 23

Motor vehicle crashes 18Motor vehicle crashes 18

Firearms 12Firearms 12

Risky sexual behavior 08Risky sexual behavior 08

Illicit drug use 07Illicit drug use 07

JAMA 2004 291 1238-45

Poor environmental quality accounts Poor environmental quality accounts for 25 of all preventable world for 25 of all preventable world

illnessillness

WHO 1997

Environmental Illness a Environmental Illness a SnapshotSnapshot

Environmental illness Environmental illness in US childrenin US children

$55 billionyear$55 billionyear Lead poisoningLead poisoning

AsthmaAsthma

CancerCancer

Developmental DisabilitiesDevelopmental Disabilities

EHP 2002 110 (7) 721-728

Healthy People 2010Healthy People 2010

National objectivesNational objectives Most significant Most significant

preventable preventable threats to health threats to health amp goals to reduce amp goals to reduce themthem

Includes Includes environmental environmental health objectiveshealth objectives

Providers role in Providers role in preventionprevention

Healthy People 2010 Toxic Healthy People 2010 Toxic WastesWastes

Lower elevated blood lead levels to Lower elevated blood lead levels to 11

Minimize risks from hazardous sitesMinimize risks from hazardous sites Reduce pesticide exposuresReduce pesticide exposures Reduce toxic pollutants produced Reduce toxic pollutants produced

disposed of treated or used for disposed of treated or used for energy recoveryenergy recovery

Increase recycling of solid waste to Increase recycling of solid waste to 3838

State of Knowledge Our State of Knowledge Our Chemical EnvironmentChemical Environment

gt80000 chemicals in gt80000 chemicals in Federal inventoryFederal inventory

2000 to 3000 NEW 2000 to 3000 NEW chemicals per yearchemicals per year

gt4 billion lbs released gt4 billion lbs released into environment yearly into environment yearly 72 million lbs of 72 million lbs of recognized carcinogens recognized carcinogens

Basic Screening Basic Screening Information Data Set Information Data Set (SIDS) avg $205000 per (SIDS) avg $205000 per chemicalchemical

Hazard Data - Chemicals Hazard Data - Chemicals Produced Produced

gt 1 Million PoundsYear gt 1 Million PoundsYear

0 10 20 30 40 50 60 70 80 90 100

Percentage Tested

Acute Toxicity

Environmental Fate

Ecotoxicity

Mutagenicity

Chronic Toxicity

ReproductiveToxicity

Full Set of BasicToxicity Tests

Medical WasteMedical Waste

6000 US hospitals~2 million 6000 US hospitals~2 million tons waste per year tons waste per year

Clinics and doctorsrsquo offices add 700000 Clinics and doctorsrsquo offices add 700000 tonstons

EPA regulations weak-HCWHh2eEPA regulations weak-HCWHh2e 850000 tons incinerated850000 tons incinerated

Pollutants inc dioxin Hg cadmium Pollutants inc dioxin Hg cadmium and Pband Pb

Segregation amp alternatives to Segregation amp alternatives to incineration incineration would cost 93 would cost 93 centspatientdaycentspatientday

Our Chemical EnvironmentOur Chemical Environment

1305 Superfund sites1305 Superfund sites 25002500 are are eligible eligible gt80kgt80k hazardous sites hazardous sites knownknown

~11 million people live within 1 mile~11 million people live within 1 mile ~25 live within 4 miles~25 live within 4 miles OR ranks 24OR ranks 24-12 Superfund sites-12 Superfund sites 3 in PDX3 in PDX Harbor Oil Portland Harbor Oil Portland

Harbor Harbor McCormick amp Baxter McCormick amp Baxter Creosoting Co Creosoting Co

Multnomah amp Washington CoMultnomah amp Washington CoShared Pollutants 2002Shared Pollutants 2002

Links to Disease Links to Disease

Methanol (gt240k lbs)Methanol (gt240k lbs)

StrongStrong ATN amp vision problems ATN amp vision problems

GoodGood Pancreatitis amp Pancreatitis amp Parkinsonrsquosmovement disorders Parkinsonrsquosmovement disorders

Ammonia (gt100k lbs)Ammonia (gt100k lbs)

StrongStrong Asthma acutechronic bronchitis Asthma acutechronic bronchitis olfactory disorders amp rhinitis olfactory disorders amp rhinitis

GoodGood Pulmonary edema Pulmonary edema

Links to Disease contLinks to Disease cont

Xylene (gt95k lbs) amp Toluene (gt83k lbs)Xylene (gt95k lbs) amp Toluene (gt83k lbs) GoodGood Scleroderma arrhythmias menstrual Scleroderma arrhythmias menstrual

do cognitive impairment hearing loss amp do cognitive impairment hearing loss amp fetal death (miscarriagestillbirth)fetal death (miscarriagestillbirth)

Glycol Ethers (gt20k lbs)Glycol Ethers (gt20k lbs) StrongStrong Reduced male fertility abnormal Reduced male fertility abnormal

sperm (morphology motility amp count) amp fetal sperm (morphology motility amp count) amp fetal death (miscarriagestillbirth) death (miscarriagestillbirth)

GoodGood ATN reduced female fertility general ATN reduced female fertility general congenital and craniofacial malformationscongenital and craniofacial malformations

National Report on Human National Report on Human Exposure to Environmental Exposure to Environmental

Chemicals Chemicals (CDC 705)(CDC 705)

Random selection from NHANES Random selection from NHANES surveysurvey

148 chemicals from 2001-2002 inc 148 chemicals from 2001-2002 inc data on 116 chemicals from 1999-data on 116 chemicals from 1999-20002000

Criteria for chemical inclusion Criteria for chemical inclusion wide exposure wide exposure serious health effects serious health effects adequate blood amp urine samples adequate blood amp urine samples efficacy of attempts to reduce efficacy of attempts to reduce

exposure exposure availability of reliable bio-monitoring availability of reliable bio-monitoring

methodmethod

CDC Report GoalsCDC Report Goals

Which chemicals are present amp Which chemicals are present amp concentrations concentrations

How many people have levels above How many people have levels above known toxicity thresholdsknown toxicity thresholds

Establish reference ranges Establish reference ranges Determine if levels are higher in at Determine if levels are higher in at

risk populations risk populations Track trends over time Track trends over time Set priorities for researchSet priorities for research

CDC Report HighlightsCDC Report Highlights

First time data for 38148 chemicalsFirst time data for 38148 chemicals BLL declining 44 of children early BLL declining 44 of children early

1990s 16 of children from 1999-1990s 16 of children from 1999-20022002

Hg in women of childbearing age Hg in women of childbearing age 57 have concerning levels57 have concerning levels

Pyrethroid insecticides (common Pyrethroid insecticides (common home use) 76 of populationhome use) 76 of population

Highlights contHighlights cont

Levels of 3 toxic pesticides- Levels of 3 toxic pesticides- Aldrin Dieldrin amp Endrin-very low Aldrin Dieldrin amp Endrin-very low

29 Dioxin-like compounds levels are 29 Dioxin-like compounds levels are declining declining

Cadmium 5 population gt20yrs age Cadmium 5 population gt20yrs age levels near toxic limit (kidney dz low levels near toxic limit (kidney dz low BMD)BMD)

Phthalates widespread higher in Phthalates widespread higher in women amp childrenwomen amp children

Limitations of Current DataLimitations of Current Data

Exposure to chemical mixtures Exposure to chemical mixtures common-research more complexcommon-research more complex

Data available for only minority Data available for only minority single agentssingle agents

Epidemiological amp animal studies Epidemiological amp animal studies often only data availableoften only data available

Result links btw Chronic Diseases amp Result links btw Chronic Diseases amp low dose chronic complex exposures low dose chronic complex exposures hard to ldquoproverdquohard to ldquoproverdquo

PROVEN HARM

PARTIALLY PROVEN

NOT YET RECOGNIZED

FOREVER UNRECOGNIZED

THE TOXIC ICEBERG________________________________________

Oregoniansrsquo HealthOregoniansrsquo Health12 CHEMICALS OF KEY CONCERN12 CHEMICALS OF KEY CONCERN 1048698 1048698 acroleinacrolein 1048698 1048698 benzenebenzene 1048698 1048698 benzo(a)pyrenebenzo(a)pyrene 1048698 1048698 bisphenol-Abisphenol-A 1048698 1048698 brominated flame retardants (BFRs)brominated flame retardants (BFRs) 1048698 1048698 dieseldiesel 1048698 1048698 dioxindioxin 1048698 1048698 formaldehydeformaldehyde 1048698 1048698 leadlead 1048698 1048698 mercurymercury home amp garden pesticideshome amp garden pesticides 1048698 1048698 phthalatesphthalates

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

A 52 yr-old pt co increasing tremor A 52 yr-old pt co increasing tremor On PE the tremor is pill-rolling and On PE the tremor is pill-rolling and resolves with intention +Romberg resolves with intention +Romberg sign unstable tandem gaitsign unstable tandem gait

You make a preliminary diagnosis of You make a preliminary diagnosis of early Parkinsonrsquos diseaseearly Parkinsonrsquos disease

Wife mentions reading about Wife mentions reading about environmental links to PD pt is a environmental links to PD pt is a farmer and has used pesticides for farmer and has used pesticides for years Could this be related to his years Could this be related to his diseasedisease

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

Paraquat rotenone organophosphates Paraquat rotenone organophosphates dieldrin and fungicides maneb amp dieldrin and fungicides maneb amp mancozeb implicatedmancozeb implicated

MPTP a designer heroin-like drug MPTP a designer heroin-like drug causes Parkinsonian syndrome in causes Parkinsonian syndrome in addictsaddicts

Higher incidence in industrialized Higher incidence in industrialized countries greatest risk in rural countries greatest risk in rural areasfarms prolonged pesticide useareasfarms prolonged pesticide use

Case control studies herbicide or Case control studies herbicide or insecticide exposure 3-4x likelyinsecticide exposure 3-4x likely

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

2005 Brown T et al Meta-analysis 2005 Brown T et al Meta-analysis of epidemi-ologic amp toxicologic of epidemi-ologic amp toxicologic studies since 1983 studies since 1983

Verified most of these links noting Verified most of these links noting limitations in study designs limitations in study designs

Conclusion ldquogeneric association btw Conclusion ldquogeneric association btw pesticide exposure amp PD exists but pesticide exposure amp PD exists but is insufficient tohellipconcludehellipa causal is insufficient tohellipconcludehellipa causal relationshiprdquo relationshiprdquo

Pesticides Genes amp PDPesticides Genes amp PD

Dr W Langston of Parkinsonrsquos Dr W Langston of Parkinsonrsquos Institute ldquoAccelerating Research on Institute ldquoAccelerating Research on Genes and Environment in Genes and Environment in Parkinsonrsquos Diseaserdquo (2005)Parkinsonrsquos Diseaserdquo (2005)

Two PD studies underway one in Two PD studies underway one in pesticide applicators other in two pesticide applicators other in two CA counties with known heavy CA counties with known heavy exposureexposure

Other Health Impacts of Other Health Impacts of PesticidesPesticides

ArrhythmiasArrhythmiasAsthmaAsthmaLymphomas Brain tumorsLymphomas Brain tumorsAbnormal sperm countsAbnormal sperm countsBirth defects amp developmental delaysBirth defects amp developmental delaysHyperactivity amp behavioral problemsHyperactivity amp behavioral problemsDecreased endurance amp coordinationDecreased endurance amp coordinationNeurocognitive problemsNeurocognitive problemsPeripheral neuropathiesPeripheral neuropathies

Pesticides a Persistent Pesticides a Persistent ProblemProblem

Major classesMajor classes insecticides fungicides insecticides fungicides herbicides rodenticidesherbicides rodenticides

1997 Market1997 Market US $119 billion World $37 US $119 billion World $37 billionbillion

HistoryHistory synthetic-new to humans amp synthetic-new to humans amp environment since 1940s gt800 licensed environment since 1940s gt800 licensed ldquoactiverdquo ingredientsldquoactiverdquo ingredients

Manufacturers Manufacturers Bayer Aventis other drug Bayer Aventis other drug coco

Inherent toxicityInherent toxicity 140 pesticides considered 140 pesticides considered neurotoxic 37 are used on food ampor feedneurotoxic 37 are used on food ampor feed

Insecticide Sites of Insecticide Sites of ActionAction

Enzymes

Axonal Membranes

Ions (Na+ K+ Ca++ Cl-)

Enzymes

Neurotransmitters

Organochlorines

Pyrethroids

Casarett and Doullrsquos Toxicology The Basic Science of Poisons 5th Edition Ed Klaassen CD

McGraw-Hill New York 1996 P 649

Organophosphorus and

Carbamate Esters

Organophosphate PesticidesOrganophosphate PesticidesOccurrence and distribution in surface amp

ground water of the United States 1992-97

httpgawaterusgsgovpublicationsabstractsofr00-187html

Background Pesticide Background Pesticide Exposures WidespreadExposures Widespread

Reported useReported use 98 of families 80 during 98 of families 80 during pregnancypregnancy

In HumansIn Humans detectable chlorpyrifos detectable chlorpyrifos metabolites in 92 of childrenrsquos 82 of metabolites in 92 of childrenrsquos 82 of adultsrsquo urine samplesadultsrsquo urine samples

In FoodIn Food residues of at least one pesticide on residues of at least one pesticide on 72 fruits amp vegetables72 fruits amp vegetables

In HomesIn Homes 3 to 9 pesticide residues found3 to 9 pesticide residues found

In AirIn Air indoor levels 10-100X higher than indoor levels 10-100X higher than outdooroutdoor

In WaterIn Water gt90 stream samples 50 of gt90 stream samples 50 of wellswells

Sources of PesticidesSources of Pesticides

Household uses lawn amp garden Household uses lawn amp garden sprays exterminators flea collarssprays exterminators flea collars

Household dust (tracking in on shoes)Household dust (tracking in on shoes)

Public schools hospitals parks Public schools hospitals parks childcare facilitieschildcare facilities

Agricultural uses amp workersrsquo clothesAgricultural uses amp workersrsquo clothes

Non-organic foodsNon-organic foods

Breast milkBreast milk

Strategies to Reduces Strategies to Reduces Exposure to Home amp Garden Exposure to Home amp Garden

Pesticides in OregonPesticides in OregonPolicy SolutionsPolicy Solutions OR pesticide use reporting system OR pesticide use reporting system

(1999) finally funded 2005(1999) finally funded 2005 Educate homeowners re nontoxic Educate homeowners re nontoxic

options options Enc pet owners to use flea combs and Enc pet owners to use flea combs and

vacuuming to control fleasvacuuming to control fleas Enc public places to use Integrated Enc public places to use Integrated

Pest Management (IPM) ie Pesticide Pest Management (IPM) ie Pesticide Free ParksFree Parks

What YOU Can Do about What YOU Can Do about PesticidesPesticides

Advise PatientsAdvise Patients Regularly dustRegularly dust Use Integrated Pest Management Use Integrated Pest Management Cleanremove shoes outsideCleanremove shoes outside Keep contaminated clothes separateKeep contaminated clothes separate Buy sustainably grown foodBuy sustainably grown food Store food in secure nontoxic Store food in secure nontoxic

containerscontainers

Mercury amp Women of Mercury amp Women of Childbearing AgeChildbearing Age

A 32 yo G0P0 woman of A 32 yo G0P0 woman of childbearing age (WCBA) childbearing age (WCBA) presents for annual PE presents for annual PE

PMH negativePMH negative

Social hx husband is Social hx husband is recreational fisherman recreational fisherman

Contemplating pregnancy Contemplating pregnancy

Should she avoid fish Should she avoid fish because of mercury risks because of mercury risks to the fetusto the fetus

Mercury amp WCBAMercury amp WCBA

gt10gt10 of WCBA exceed safe limit of of WCBA exceed safe limit of 1ugkgday1ugkgday

5050 of women of women who eat fishwho eat fish exceed exceed limitlimit

5757 of WCBA have Hg levels of WCBA have Hg levels concerning for adverse effects concerning for adverse effects (CDC (CDC Natrsquol Report 0705Natrsquol Report 0705))

Higher risk Higher risk 300 000 childrenyear 300 000 childrenyear subsistence fishers immigrants subsistence fishers immigrants Native AmericansNative Americans

Mercury amp WCBAMercury amp WCBA

Hg enters tissues variable excretionHg enters tissues variable excretion Breast Milk PCBs DDT amp other Breast Milk PCBs DDT amp other

pesticides dioxins dibenzofurans pesticides dioxins dibenzofurans toxic flame retardants amp heavy toxic flame retardants amp heavy metals (Pb amp Hg) metals (Pb amp Hg)

No bio-accumulation in milk but No bio-accumulation in milk but levels in fish-eaters may exceed levels in fish-eaters may exceed unexposed women by 100x unexposed women by 100x

Scientific evidence indicates Scientific evidence indicates advantages of breast-feeding advantages of breast-feeding outweigh riskshellipoutweigh riskshellip

Neuro Effects of MercuryNeuro Effects of Mercury

Cerebral palsyCerebral palsy MRDDMRDD disequilibrium ataxiadisequilibrium ataxia hearing lossdeafnesshearing lossdeafness visual visual

impairmentblindnessimpairmentblindness peripheral neuropathyperipheral neuropathy parasthesiasparasthesias tremors seizures tremors seizures abnl reflexes amp muscle toneabnl reflexes amp muscle tone Psychiatric disturbances Psychiatric disturbances

Mercury a Persistent Mercury a Persistent ProblemProblem

PoisoningsPoisonings Minamata 1950s amp Iraq Minamata 1950s amp Iraq 19711971

Nationally ~Nationally ~160 tons of Hg annually160 tons of Hg annually In OregonIn Oregon ~ ~4500 lbs annually4500 lbs annually Lack of regulationLack of regulation In OR 10 facilities In OR 10 facilities

report Hg release-none has a permit or is report Hg release-none has a permit or is required to monitor emissions by staterequired to monitor emissions by state

Fish AdvisoriesFish Advisories in 2004 45 states had in 2004 45 states had gt2000 warnings Oregon lists advisories gt2000 warnings Oregon lists advisories for 12 water bodies inc Willamette for 12 water bodies inc Willamette

Atmospheric HgAtmospheric Hg

The Mercury CycleThe Mercury Cycle

MercuryMercuryDeclining Threshold of Declining Threshold of

HarmHarm

2000199019801970001

01

1

10

100

YEAR

Level associated with harmful effectRegulatory standard (maximum safe exposure or high end exposure from allowed fish contamination)

FDA WHO

EPA

ATSDR

DA

ILY

IN

TA

KE

(mic

rogr

ams

kg

day

Hg)

Sources of MercurySources of MercuryIndustrial emissions Industrial emissions

coal fired plantscoal fired plantsMunicipal amp medical Municipal amp medical

waste incineratorswaste incineratorsAbandoned Hg amp gold Abandoned Hg amp gold

minesminesNatural off-gassing Natural off-gassing Dental amalgamsDental amalgamsBioaccumulation in Bioaccumulation in

foods esp fishfoods esp fishOld thermometers BP Old thermometers BP

cuffs amp auto cuffs amp auto switchesswitches

Strategies to Reduce Strategies to Reduce Mercury Pollution in Mercury Pollution in

OregonOregonPolicy SolutionsPolicy Solutions Mercury Solutions Act of 2001Mercury Solutions Act of 2001 Ensure safe collection amp recyclingEnsure safe collection amp recycling Clean up abandoned mines and Clean up abandoned mines and

SuperfundsSuperfunds Reduce Hg emissions from health Reduce Hg emissions from health

care facilitiescare facilities Inc Hg in applicable DEQ air amp Inc Hg in applicable DEQ air amp

water permitswater permits Coal burning power plant Boardman Coal burning power plant Boardman

OR OR Implement OR Executive OrderImplement OR Executive Order

What YOU Can Do about What YOU Can Do about MercuryMercury

Advise PatientsAdvise Patients Provide Provide An Expectant Motherrsquos Guide to An Expectant Motherrsquos Guide to

Eating Fish in Oregon (DHS) Eating Fish in Oregon (DHS) in waiting in waiting roomsrooms

Rec WCBA and children avoid fish wHgRec WCBA and children avoid fish wHg Enc WCBA to consume low-fat dietEnc WCBA to consume low-fat diet Recycle old Hg thermometers Recycle old Hg thermometers

thermostats amp fluorescent light tubesthermostats amp fluorescent light tubes Have car checked for Hg switches at Have car checked for Hg switches at

participating auto shop (free participating auto shop (free replacement)replacement)

Use digital thermometers amp thermostatsUse digital thermometers amp thermostats

SummarySummary Chronic Diseases are prevalent Toxic Chronic Diseases are prevalent Toxic

exposures are possible exposures are possible preventablepreventable contributorscontributors

Pesticides amp risk of Parkinsonrsquos and Mercury Pesticides amp risk of Parkinsonrsquos and Mercury risks to WCBA are more understood than most risks to WCBA are more understood than most toxins and other chronic diseasestoxins and other chronic diseases

Apparent toxicity at high doses should be a Apparent toxicity at high doses should be a red flag for possible harm from low dose red flag for possible harm from low dose chronic exposureschronic exposures

Since ldquoproofrdquo of harm materializes slowly Since ldquoproofrdquo of harm materializes slowly generations are at risk and may be harmed generations are at risk and may be harmed before adequate regulatory response occursbefore adequate regulatory response occurs

Kaiser amp HCWHh2eKaiser amp HCWHh2e

Clean Diesel Hospital Zones ProjectClean Diesel Hospital Zones Project Healthy Food in Healthcare InitiativeHealthy Food in Healthcare Initiative Green Building PVC and DEHP free Green Building PVC and DEHP free

NICU NICU Environmentally preferable purchasing Environmentally preferable purchasing

policypolicy Making Medicine Mercury Free Award Making Medicine Mercury Free Award h2e Environmental Leadership Award h2e Environmental Leadership Award

20022002

What Can You DoWhat Can You Do

Be aware of environmental toxins amp Be aware of environmental toxins amp their possible links to chronic diseasestheir possible links to chronic diseases

Provide advice amp education on Provide advice amp education on prevention andor minimizing prevention andor minimizing exposures or refer appropriately exposures or refer appropriately

Incorporate environmental questions Incorporate environmental questions into clinical historyinto clinical history

Advocate Advocate wwwenvirohealthactionorgwwwenvirohealthactionorg

Local AdvocacyLocal Advocacy Oregon Environmental CouncilOregon Environmental Council wwwoeconlineorgwwwoeconlineorg Oregon Collaborative on Health amp Oregon Collaborative on Health amp

EnvironmentEnvironment Healthy Environment ForumsHealthy Environment Forums Oregon Center for Environmental HealthOregon Center for Environmental Health wwworegon-healthorgwwworegon-healthorg Healthcare without HarmHealthcare without Harm Hospitals for Healthy Environment (h2e)Hospitals for Healthy Environment (h2e) Oregon PSROregon PSR wwworegonpsrorgwwworegonpsrorg Environmental Health-In Harmrsquos Way Environmental Health-In Harmrsquos Way

Poor environmental quality accounts Poor environmental quality accounts for 25 of all preventable world for 25 of all preventable world

illnessillness

WHO 1997

Environmental Illness a Environmental Illness a SnapshotSnapshot

Environmental illness Environmental illness in US childrenin US children

$55 billionyear$55 billionyear Lead poisoningLead poisoning

AsthmaAsthma

CancerCancer

Developmental DisabilitiesDevelopmental Disabilities

EHP 2002 110 (7) 721-728

Healthy People 2010Healthy People 2010

National objectivesNational objectives Most significant Most significant

preventable preventable threats to health threats to health amp goals to reduce amp goals to reduce themthem

Includes Includes environmental environmental health objectiveshealth objectives

Providers role in Providers role in preventionprevention

Healthy People 2010 Toxic Healthy People 2010 Toxic WastesWastes

Lower elevated blood lead levels to Lower elevated blood lead levels to 11

Minimize risks from hazardous sitesMinimize risks from hazardous sites Reduce pesticide exposuresReduce pesticide exposures Reduce toxic pollutants produced Reduce toxic pollutants produced

disposed of treated or used for disposed of treated or used for energy recoveryenergy recovery

Increase recycling of solid waste to Increase recycling of solid waste to 3838

State of Knowledge Our State of Knowledge Our Chemical EnvironmentChemical Environment

gt80000 chemicals in gt80000 chemicals in Federal inventoryFederal inventory

2000 to 3000 NEW 2000 to 3000 NEW chemicals per yearchemicals per year

gt4 billion lbs released gt4 billion lbs released into environment yearly into environment yearly 72 million lbs of 72 million lbs of recognized carcinogens recognized carcinogens

Basic Screening Basic Screening Information Data Set Information Data Set (SIDS) avg $205000 per (SIDS) avg $205000 per chemicalchemical

Hazard Data - Chemicals Hazard Data - Chemicals Produced Produced

gt 1 Million PoundsYear gt 1 Million PoundsYear

0 10 20 30 40 50 60 70 80 90 100

Percentage Tested

Acute Toxicity

Environmental Fate

Ecotoxicity

Mutagenicity

Chronic Toxicity

ReproductiveToxicity

Full Set of BasicToxicity Tests

Medical WasteMedical Waste

6000 US hospitals~2 million 6000 US hospitals~2 million tons waste per year tons waste per year

Clinics and doctorsrsquo offices add 700000 Clinics and doctorsrsquo offices add 700000 tonstons

EPA regulations weak-HCWHh2eEPA regulations weak-HCWHh2e 850000 tons incinerated850000 tons incinerated

Pollutants inc dioxin Hg cadmium Pollutants inc dioxin Hg cadmium and Pband Pb

Segregation amp alternatives to Segregation amp alternatives to incineration incineration would cost 93 would cost 93 centspatientdaycentspatientday

Our Chemical EnvironmentOur Chemical Environment

1305 Superfund sites1305 Superfund sites 25002500 are are eligible eligible gt80kgt80k hazardous sites hazardous sites knownknown

~11 million people live within 1 mile~11 million people live within 1 mile ~25 live within 4 miles~25 live within 4 miles OR ranks 24OR ranks 24-12 Superfund sites-12 Superfund sites 3 in PDX3 in PDX Harbor Oil Portland Harbor Oil Portland

Harbor Harbor McCormick amp Baxter McCormick amp Baxter Creosoting Co Creosoting Co

Multnomah amp Washington CoMultnomah amp Washington CoShared Pollutants 2002Shared Pollutants 2002

Links to Disease Links to Disease

Methanol (gt240k lbs)Methanol (gt240k lbs)

StrongStrong ATN amp vision problems ATN amp vision problems

GoodGood Pancreatitis amp Pancreatitis amp Parkinsonrsquosmovement disorders Parkinsonrsquosmovement disorders

Ammonia (gt100k lbs)Ammonia (gt100k lbs)

StrongStrong Asthma acutechronic bronchitis Asthma acutechronic bronchitis olfactory disorders amp rhinitis olfactory disorders amp rhinitis

GoodGood Pulmonary edema Pulmonary edema

Links to Disease contLinks to Disease cont

Xylene (gt95k lbs) amp Toluene (gt83k lbs)Xylene (gt95k lbs) amp Toluene (gt83k lbs) GoodGood Scleroderma arrhythmias menstrual Scleroderma arrhythmias menstrual

do cognitive impairment hearing loss amp do cognitive impairment hearing loss amp fetal death (miscarriagestillbirth)fetal death (miscarriagestillbirth)

Glycol Ethers (gt20k lbs)Glycol Ethers (gt20k lbs) StrongStrong Reduced male fertility abnormal Reduced male fertility abnormal

sperm (morphology motility amp count) amp fetal sperm (morphology motility amp count) amp fetal death (miscarriagestillbirth) death (miscarriagestillbirth)

GoodGood ATN reduced female fertility general ATN reduced female fertility general congenital and craniofacial malformationscongenital and craniofacial malformations

National Report on Human National Report on Human Exposure to Environmental Exposure to Environmental

Chemicals Chemicals (CDC 705)(CDC 705)

Random selection from NHANES Random selection from NHANES surveysurvey

148 chemicals from 2001-2002 inc 148 chemicals from 2001-2002 inc data on 116 chemicals from 1999-data on 116 chemicals from 1999-20002000

Criteria for chemical inclusion Criteria for chemical inclusion wide exposure wide exposure serious health effects serious health effects adequate blood amp urine samples adequate blood amp urine samples efficacy of attempts to reduce efficacy of attempts to reduce

exposure exposure availability of reliable bio-monitoring availability of reliable bio-monitoring

methodmethod

CDC Report GoalsCDC Report Goals

Which chemicals are present amp Which chemicals are present amp concentrations concentrations

How many people have levels above How many people have levels above known toxicity thresholdsknown toxicity thresholds

Establish reference ranges Establish reference ranges Determine if levels are higher in at Determine if levels are higher in at

risk populations risk populations Track trends over time Track trends over time Set priorities for researchSet priorities for research

CDC Report HighlightsCDC Report Highlights

First time data for 38148 chemicalsFirst time data for 38148 chemicals BLL declining 44 of children early BLL declining 44 of children early

1990s 16 of children from 1999-1990s 16 of children from 1999-20022002

Hg in women of childbearing age Hg in women of childbearing age 57 have concerning levels57 have concerning levels

Pyrethroid insecticides (common Pyrethroid insecticides (common home use) 76 of populationhome use) 76 of population

Highlights contHighlights cont

Levels of 3 toxic pesticides- Levels of 3 toxic pesticides- Aldrin Dieldrin amp Endrin-very low Aldrin Dieldrin amp Endrin-very low

29 Dioxin-like compounds levels are 29 Dioxin-like compounds levels are declining declining

Cadmium 5 population gt20yrs age Cadmium 5 population gt20yrs age levels near toxic limit (kidney dz low levels near toxic limit (kidney dz low BMD)BMD)

Phthalates widespread higher in Phthalates widespread higher in women amp childrenwomen amp children

Limitations of Current DataLimitations of Current Data

Exposure to chemical mixtures Exposure to chemical mixtures common-research more complexcommon-research more complex

Data available for only minority Data available for only minority single agentssingle agents

Epidemiological amp animal studies Epidemiological amp animal studies often only data availableoften only data available

Result links btw Chronic Diseases amp Result links btw Chronic Diseases amp low dose chronic complex exposures low dose chronic complex exposures hard to ldquoproverdquohard to ldquoproverdquo

PROVEN HARM

PARTIALLY PROVEN

NOT YET RECOGNIZED

FOREVER UNRECOGNIZED

THE TOXIC ICEBERG________________________________________

Oregoniansrsquo HealthOregoniansrsquo Health12 CHEMICALS OF KEY CONCERN12 CHEMICALS OF KEY CONCERN 1048698 1048698 acroleinacrolein 1048698 1048698 benzenebenzene 1048698 1048698 benzo(a)pyrenebenzo(a)pyrene 1048698 1048698 bisphenol-Abisphenol-A 1048698 1048698 brominated flame retardants (BFRs)brominated flame retardants (BFRs) 1048698 1048698 dieseldiesel 1048698 1048698 dioxindioxin 1048698 1048698 formaldehydeformaldehyde 1048698 1048698 leadlead 1048698 1048698 mercurymercury home amp garden pesticideshome amp garden pesticides 1048698 1048698 phthalatesphthalates

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

A 52 yr-old pt co increasing tremor A 52 yr-old pt co increasing tremor On PE the tremor is pill-rolling and On PE the tremor is pill-rolling and resolves with intention +Romberg resolves with intention +Romberg sign unstable tandem gaitsign unstable tandem gait

You make a preliminary diagnosis of You make a preliminary diagnosis of early Parkinsonrsquos diseaseearly Parkinsonrsquos disease

Wife mentions reading about Wife mentions reading about environmental links to PD pt is a environmental links to PD pt is a farmer and has used pesticides for farmer and has used pesticides for years Could this be related to his years Could this be related to his diseasedisease

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

Paraquat rotenone organophosphates Paraquat rotenone organophosphates dieldrin and fungicides maneb amp dieldrin and fungicides maneb amp mancozeb implicatedmancozeb implicated

MPTP a designer heroin-like drug MPTP a designer heroin-like drug causes Parkinsonian syndrome in causes Parkinsonian syndrome in addictsaddicts

Higher incidence in industrialized Higher incidence in industrialized countries greatest risk in rural countries greatest risk in rural areasfarms prolonged pesticide useareasfarms prolonged pesticide use

Case control studies herbicide or Case control studies herbicide or insecticide exposure 3-4x likelyinsecticide exposure 3-4x likely

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

2005 Brown T et al Meta-analysis 2005 Brown T et al Meta-analysis of epidemi-ologic amp toxicologic of epidemi-ologic amp toxicologic studies since 1983 studies since 1983

Verified most of these links noting Verified most of these links noting limitations in study designs limitations in study designs

Conclusion ldquogeneric association btw Conclusion ldquogeneric association btw pesticide exposure amp PD exists but pesticide exposure amp PD exists but is insufficient tohellipconcludehellipa causal is insufficient tohellipconcludehellipa causal relationshiprdquo relationshiprdquo

Pesticides Genes amp PDPesticides Genes amp PD

Dr W Langston of Parkinsonrsquos Dr W Langston of Parkinsonrsquos Institute ldquoAccelerating Research on Institute ldquoAccelerating Research on Genes and Environment in Genes and Environment in Parkinsonrsquos Diseaserdquo (2005)Parkinsonrsquos Diseaserdquo (2005)

Two PD studies underway one in Two PD studies underway one in pesticide applicators other in two pesticide applicators other in two CA counties with known heavy CA counties with known heavy exposureexposure

Other Health Impacts of Other Health Impacts of PesticidesPesticides

ArrhythmiasArrhythmiasAsthmaAsthmaLymphomas Brain tumorsLymphomas Brain tumorsAbnormal sperm countsAbnormal sperm countsBirth defects amp developmental delaysBirth defects amp developmental delaysHyperactivity amp behavioral problemsHyperactivity amp behavioral problemsDecreased endurance amp coordinationDecreased endurance amp coordinationNeurocognitive problemsNeurocognitive problemsPeripheral neuropathiesPeripheral neuropathies

Pesticides a Persistent Pesticides a Persistent ProblemProblem

Major classesMajor classes insecticides fungicides insecticides fungicides herbicides rodenticidesherbicides rodenticides

1997 Market1997 Market US $119 billion World $37 US $119 billion World $37 billionbillion

HistoryHistory synthetic-new to humans amp synthetic-new to humans amp environment since 1940s gt800 licensed environment since 1940s gt800 licensed ldquoactiverdquo ingredientsldquoactiverdquo ingredients

Manufacturers Manufacturers Bayer Aventis other drug Bayer Aventis other drug coco

Inherent toxicityInherent toxicity 140 pesticides considered 140 pesticides considered neurotoxic 37 are used on food ampor feedneurotoxic 37 are used on food ampor feed

Insecticide Sites of Insecticide Sites of ActionAction

Enzymes

Axonal Membranes

Ions (Na+ K+ Ca++ Cl-)

Enzymes

Neurotransmitters

Organochlorines

Pyrethroids

Casarett and Doullrsquos Toxicology The Basic Science of Poisons 5th Edition Ed Klaassen CD

McGraw-Hill New York 1996 P 649

Organophosphorus and

Carbamate Esters

Organophosphate PesticidesOrganophosphate PesticidesOccurrence and distribution in surface amp

ground water of the United States 1992-97

httpgawaterusgsgovpublicationsabstractsofr00-187html

Background Pesticide Background Pesticide Exposures WidespreadExposures Widespread

Reported useReported use 98 of families 80 during 98 of families 80 during pregnancypregnancy

In HumansIn Humans detectable chlorpyrifos detectable chlorpyrifos metabolites in 92 of childrenrsquos 82 of metabolites in 92 of childrenrsquos 82 of adultsrsquo urine samplesadultsrsquo urine samples

In FoodIn Food residues of at least one pesticide on residues of at least one pesticide on 72 fruits amp vegetables72 fruits amp vegetables

In HomesIn Homes 3 to 9 pesticide residues found3 to 9 pesticide residues found

In AirIn Air indoor levels 10-100X higher than indoor levels 10-100X higher than outdooroutdoor

In WaterIn Water gt90 stream samples 50 of gt90 stream samples 50 of wellswells

Sources of PesticidesSources of Pesticides

Household uses lawn amp garden Household uses lawn amp garden sprays exterminators flea collarssprays exterminators flea collars

Household dust (tracking in on shoes)Household dust (tracking in on shoes)

Public schools hospitals parks Public schools hospitals parks childcare facilitieschildcare facilities

Agricultural uses amp workersrsquo clothesAgricultural uses amp workersrsquo clothes

Non-organic foodsNon-organic foods

Breast milkBreast milk

Strategies to Reduces Strategies to Reduces Exposure to Home amp Garden Exposure to Home amp Garden

Pesticides in OregonPesticides in OregonPolicy SolutionsPolicy Solutions OR pesticide use reporting system OR pesticide use reporting system

(1999) finally funded 2005(1999) finally funded 2005 Educate homeowners re nontoxic Educate homeowners re nontoxic

options options Enc pet owners to use flea combs and Enc pet owners to use flea combs and

vacuuming to control fleasvacuuming to control fleas Enc public places to use Integrated Enc public places to use Integrated

Pest Management (IPM) ie Pesticide Pest Management (IPM) ie Pesticide Free ParksFree Parks

What YOU Can Do about What YOU Can Do about PesticidesPesticides

Advise PatientsAdvise Patients Regularly dustRegularly dust Use Integrated Pest Management Use Integrated Pest Management Cleanremove shoes outsideCleanremove shoes outside Keep contaminated clothes separateKeep contaminated clothes separate Buy sustainably grown foodBuy sustainably grown food Store food in secure nontoxic Store food in secure nontoxic

containerscontainers

Mercury amp Women of Mercury amp Women of Childbearing AgeChildbearing Age

A 32 yo G0P0 woman of A 32 yo G0P0 woman of childbearing age (WCBA) childbearing age (WCBA) presents for annual PE presents for annual PE

PMH negativePMH negative

Social hx husband is Social hx husband is recreational fisherman recreational fisherman

Contemplating pregnancy Contemplating pregnancy

Should she avoid fish Should she avoid fish because of mercury risks because of mercury risks to the fetusto the fetus

Mercury amp WCBAMercury amp WCBA

gt10gt10 of WCBA exceed safe limit of of WCBA exceed safe limit of 1ugkgday1ugkgday

5050 of women of women who eat fishwho eat fish exceed exceed limitlimit

5757 of WCBA have Hg levels of WCBA have Hg levels concerning for adverse effects concerning for adverse effects (CDC (CDC Natrsquol Report 0705Natrsquol Report 0705))

Higher risk Higher risk 300 000 childrenyear 300 000 childrenyear subsistence fishers immigrants subsistence fishers immigrants Native AmericansNative Americans

Mercury amp WCBAMercury amp WCBA

Hg enters tissues variable excretionHg enters tissues variable excretion Breast Milk PCBs DDT amp other Breast Milk PCBs DDT amp other

pesticides dioxins dibenzofurans pesticides dioxins dibenzofurans toxic flame retardants amp heavy toxic flame retardants amp heavy metals (Pb amp Hg) metals (Pb amp Hg)

No bio-accumulation in milk but No bio-accumulation in milk but levels in fish-eaters may exceed levels in fish-eaters may exceed unexposed women by 100x unexposed women by 100x

Scientific evidence indicates Scientific evidence indicates advantages of breast-feeding advantages of breast-feeding outweigh riskshellipoutweigh riskshellip

Neuro Effects of MercuryNeuro Effects of Mercury

Cerebral palsyCerebral palsy MRDDMRDD disequilibrium ataxiadisequilibrium ataxia hearing lossdeafnesshearing lossdeafness visual visual

impairmentblindnessimpairmentblindness peripheral neuropathyperipheral neuropathy parasthesiasparasthesias tremors seizures tremors seizures abnl reflexes amp muscle toneabnl reflexes amp muscle tone Psychiatric disturbances Psychiatric disturbances

Mercury a Persistent Mercury a Persistent ProblemProblem

PoisoningsPoisonings Minamata 1950s amp Iraq Minamata 1950s amp Iraq 19711971

Nationally ~Nationally ~160 tons of Hg annually160 tons of Hg annually In OregonIn Oregon ~ ~4500 lbs annually4500 lbs annually Lack of regulationLack of regulation In OR 10 facilities In OR 10 facilities

report Hg release-none has a permit or is report Hg release-none has a permit or is required to monitor emissions by staterequired to monitor emissions by state

Fish AdvisoriesFish Advisories in 2004 45 states had in 2004 45 states had gt2000 warnings Oregon lists advisories gt2000 warnings Oregon lists advisories for 12 water bodies inc Willamette for 12 water bodies inc Willamette

Atmospheric HgAtmospheric Hg

The Mercury CycleThe Mercury Cycle

MercuryMercuryDeclining Threshold of Declining Threshold of

HarmHarm

2000199019801970001

01

1

10

100

YEAR

Level associated with harmful effectRegulatory standard (maximum safe exposure or high end exposure from allowed fish contamination)

FDA WHO

EPA

ATSDR

DA

ILY

IN

TA

KE

(mic

rogr

ams

kg

day

Hg)

Sources of MercurySources of MercuryIndustrial emissions Industrial emissions

coal fired plantscoal fired plantsMunicipal amp medical Municipal amp medical

waste incineratorswaste incineratorsAbandoned Hg amp gold Abandoned Hg amp gold

minesminesNatural off-gassing Natural off-gassing Dental amalgamsDental amalgamsBioaccumulation in Bioaccumulation in

foods esp fishfoods esp fishOld thermometers BP Old thermometers BP

cuffs amp auto cuffs amp auto switchesswitches

Strategies to Reduce Strategies to Reduce Mercury Pollution in Mercury Pollution in

OregonOregonPolicy SolutionsPolicy Solutions Mercury Solutions Act of 2001Mercury Solutions Act of 2001 Ensure safe collection amp recyclingEnsure safe collection amp recycling Clean up abandoned mines and Clean up abandoned mines and

SuperfundsSuperfunds Reduce Hg emissions from health Reduce Hg emissions from health

care facilitiescare facilities Inc Hg in applicable DEQ air amp Inc Hg in applicable DEQ air amp

water permitswater permits Coal burning power plant Boardman Coal burning power plant Boardman

OR OR Implement OR Executive OrderImplement OR Executive Order

What YOU Can Do about What YOU Can Do about MercuryMercury

Advise PatientsAdvise Patients Provide Provide An Expectant Motherrsquos Guide to An Expectant Motherrsquos Guide to

Eating Fish in Oregon (DHS) Eating Fish in Oregon (DHS) in waiting in waiting roomsrooms

Rec WCBA and children avoid fish wHgRec WCBA and children avoid fish wHg Enc WCBA to consume low-fat dietEnc WCBA to consume low-fat diet Recycle old Hg thermometers Recycle old Hg thermometers

thermostats amp fluorescent light tubesthermostats amp fluorescent light tubes Have car checked for Hg switches at Have car checked for Hg switches at

participating auto shop (free participating auto shop (free replacement)replacement)

Use digital thermometers amp thermostatsUse digital thermometers amp thermostats

SummarySummary Chronic Diseases are prevalent Toxic Chronic Diseases are prevalent Toxic

exposures are possible exposures are possible preventablepreventable contributorscontributors

Pesticides amp risk of Parkinsonrsquos and Mercury Pesticides amp risk of Parkinsonrsquos and Mercury risks to WCBA are more understood than most risks to WCBA are more understood than most toxins and other chronic diseasestoxins and other chronic diseases

Apparent toxicity at high doses should be a Apparent toxicity at high doses should be a red flag for possible harm from low dose red flag for possible harm from low dose chronic exposureschronic exposures

Since ldquoproofrdquo of harm materializes slowly Since ldquoproofrdquo of harm materializes slowly generations are at risk and may be harmed generations are at risk and may be harmed before adequate regulatory response occursbefore adequate regulatory response occurs

Kaiser amp HCWHh2eKaiser amp HCWHh2e

Clean Diesel Hospital Zones ProjectClean Diesel Hospital Zones Project Healthy Food in Healthcare InitiativeHealthy Food in Healthcare Initiative Green Building PVC and DEHP free Green Building PVC and DEHP free

NICU NICU Environmentally preferable purchasing Environmentally preferable purchasing

policypolicy Making Medicine Mercury Free Award Making Medicine Mercury Free Award h2e Environmental Leadership Award h2e Environmental Leadership Award

20022002

What Can You DoWhat Can You Do

Be aware of environmental toxins amp Be aware of environmental toxins amp their possible links to chronic diseasestheir possible links to chronic diseases

Provide advice amp education on Provide advice amp education on prevention andor minimizing prevention andor minimizing exposures or refer appropriately exposures or refer appropriately

Incorporate environmental questions Incorporate environmental questions into clinical historyinto clinical history

Advocate Advocate wwwenvirohealthactionorgwwwenvirohealthactionorg

Local AdvocacyLocal Advocacy Oregon Environmental CouncilOregon Environmental Council wwwoeconlineorgwwwoeconlineorg Oregon Collaborative on Health amp Oregon Collaborative on Health amp

EnvironmentEnvironment Healthy Environment ForumsHealthy Environment Forums Oregon Center for Environmental HealthOregon Center for Environmental Health wwworegon-healthorgwwworegon-healthorg Healthcare without HarmHealthcare without Harm Hospitals for Healthy Environment (h2e)Hospitals for Healthy Environment (h2e) Oregon PSROregon PSR wwworegonpsrorgwwworegonpsrorg Environmental Health-In Harmrsquos Way Environmental Health-In Harmrsquos Way

Environmental Illness a Environmental Illness a SnapshotSnapshot

Environmental illness Environmental illness in US childrenin US children

$55 billionyear$55 billionyear Lead poisoningLead poisoning

AsthmaAsthma

CancerCancer

Developmental DisabilitiesDevelopmental Disabilities

EHP 2002 110 (7) 721-728

Healthy People 2010Healthy People 2010

National objectivesNational objectives Most significant Most significant

preventable preventable threats to health threats to health amp goals to reduce amp goals to reduce themthem

Includes Includes environmental environmental health objectiveshealth objectives

Providers role in Providers role in preventionprevention

Healthy People 2010 Toxic Healthy People 2010 Toxic WastesWastes

Lower elevated blood lead levels to Lower elevated blood lead levels to 11

Minimize risks from hazardous sitesMinimize risks from hazardous sites Reduce pesticide exposuresReduce pesticide exposures Reduce toxic pollutants produced Reduce toxic pollutants produced

disposed of treated or used for disposed of treated or used for energy recoveryenergy recovery

Increase recycling of solid waste to Increase recycling of solid waste to 3838

State of Knowledge Our State of Knowledge Our Chemical EnvironmentChemical Environment

gt80000 chemicals in gt80000 chemicals in Federal inventoryFederal inventory

2000 to 3000 NEW 2000 to 3000 NEW chemicals per yearchemicals per year

gt4 billion lbs released gt4 billion lbs released into environment yearly into environment yearly 72 million lbs of 72 million lbs of recognized carcinogens recognized carcinogens

Basic Screening Basic Screening Information Data Set Information Data Set (SIDS) avg $205000 per (SIDS) avg $205000 per chemicalchemical

Hazard Data - Chemicals Hazard Data - Chemicals Produced Produced

gt 1 Million PoundsYear gt 1 Million PoundsYear

0 10 20 30 40 50 60 70 80 90 100

Percentage Tested

Acute Toxicity

Environmental Fate

Ecotoxicity

Mutagenicity

Chronic Toxicity

ReproductiveToxicity

Full Set of BasicToxicity Tests

Medical WasteMedical Waste

6000 US hospitals~2 million 6000 US hospitals~2 million tons waste per year tons waste per year

Clinics and doctorsrsquo offices add 700000 Clinics and doctorsrsquo offices add 700000 tonstons

EPA regulations weak-HCWHh2eEPA regulations weak-HCWHh2e 850000 tons incinerated850000 tons incinerated

Pollutants inc dioxin Hg cadmium Pollutants inc dioxin Hg cadmium and Pband Pb

Segregation amp alternatives to Segregation amp alternatives to incineration incineration would cost 93 would cost 93 centspatientdaycentspatientday

Our Chemical EnvironmentOur Chemical Environment

1305 Superfund sites1305 Superfund sites 25002500 are are eligible eligible gt80kgt80k hazardous sites hazardous sites knownknown

~11 million people live within 1 mile~11 million people live within 1 mile ~25 live within 4 miles~25 live within 4 miles OR ranks 24OR ranks 24-12 Superfund sites-12 Superfund sites 3 in PDX3 in PDX Harbor Oil Portland Harbor Oil Portland

Harbor Harbor McCormick amp Baxter McCormick amp Baxter Creosoting Co Creosoting Co

Multnomah amp Washington CoMultnomah amp Washington CoShared Pollutants 2002Shared Pollutants 2002

Links to Disease Links to Disease

Methanol (gt240k lbs)Methanol (gt240k lbs)

StrongStrong ATN amp vision problems ATN amp vision problems

GoodGood Pancreatitis amp Pancreatitis amp Parkinsonrsquosmovement disorders Parkinsonrsquosmovement disorders

Ammonia (gt100k lbs)Ammonia (gt100k lbs)

StrongStrong Asthma acutechronic bronchitis Asthma acutechronic bronchitis olfactory disorders amp rhinitis olfactory disorders amp rhinitis

GoodGood Pulmonary edema Pulmonary edema

Links to Disease contLinks to Disease cont

Xylene (gt95k lbs) amp Toluene (gt83k lbs)Xylene (gt95k lbs) amp Toluene (gt83k lbs) GoodGood Scleroderma arrhythmias menstrual Scleroderma arrhythmias menstrual

do cognitive impairment hearing loss amp do cognitive impairment hearing loss amp fetal death (miscarriagestillbirth)fetal death (miscarriagestillbirth)

Glycol Ethers (gt20k lbs)Glycol Ethers (gt20k lbs) StrongStrong Reduced male fertility abnormal Reduced male fertility abnormal

sperm (morphology motility amp count) amp fetal sperm (morphology motility amp count) amp fetal death (miscarriagestillbirth) death (miscarriagestillbirth)

GoodGood ATN reduced female fertility general ATN reduced female fertility general congenital and craniofacial malformationscongenital and craniofacial malformations

National Report on Human National Report on Human Exposure to Environmental Exposure to Environmental

Chemicals Chemicals (CDC 705)(CDC 705)

Random selection from NHANES Random selection from NHANES surveysurvey

148 chemicals from 2001-2002 inc 148 chemicals from 2001-2002 inc data on 116 chemicals from 1999-data on 116 chemicals from 1999-20002000

Criteria for chemical inclusion Criteria for chemical inclusion wide exposure wide exposure serious health effects serious health effects adequate blood amp urine samples adequate blood amp urine samples efficacy of attempts to reduce efficacy of attempts to reduce

exposure exposure availability of reliable bio-monitoring availability of reliable bio-monitoring

methodmethod

CDC Report GoalsCDC Report Goals

Which chemicals are present amp Which chemicals are present amp concentrations concentrations

How many people have levels above How many people have levels above known toxicity thresholdsknown toxicity thresholds

Establish reference ranges Establish reference ranges Determine if levels are higher in at Determine if levels are higher in at

risk populations risk populations Track trends over time Track trends over time Set priorities for researchSet priorities for research

CDC Report HighlightsCDC Report Highlights

First time data for 38148 chemicalsFirst time data for 38148 chemicals BLL declining 44 of children early BLL declining 44 of children early

1990s 16 of children from 1999-1990s 16 of children from 1999-20022002

Hg in women of childbearing age Hg in women of childbearing age 57 have concerning levels57 have concerning levels

Pyrethroid insecticides (common Pyrethroid insecticides (common home use) 76 of populationhome use) 76 of population

Highlights contHighlights cont

Levels of 3 toxic pesticides- Levels of 3 toxic pesticides- Aldrin Dieldrin amp Endrin-very low Aldrin Dieldrin amp Endrin-very low

29 Dioxin-like compounds levels are 29 Dioxin-like compounds levels are declining declining

Cadmium 5 population gt20yrs age Cadmium 5 population gt20yrs age levels near toxic limit (kidney dz low levels near toxic limit (kidney dz low BMD)BMD)

Phthalates widespread higher in Phthalates widespread higher in women amp childrenwomen amp children

Limitations of Current DataLimitations of Current Data

Exposure to chemical mixtures Exposure to chemical mixtures common-research more complexcommon-research more complex

Data available for only minority Data available for only minority single agentssingle agents

Epidemiological amp animal studies Epidemiological amp animal studies often only data availableoften only data available

Result links btw Chronic Diseases amp Result links btw Chronic Diseases amp low dose chronic complex exposures low dose chronic complex exposures hard to ldquoproverdquohard to ldquoproverdquo

PROVEN HARM

PARTIALLY PROVEN

NOT YET RECOGNIZED

FOREVER UNRECOGNIZED

THE TOXIC ICEBERG________________________________________

Oregoniansrsquo HealthOregoniansrsquo Health12 CHEMICALS OF KEY CONCERN12 CHEMICALS OF KEY CONCERN 1048698 1048698 acroleinacrolein 1048698 1048698 benzenebenzene 1048698 1048698 benzo(a)pyrenebenzo(a)pyrene 1048698 1048698 bisphenol-Abisphenol-A 1048698 1048698 brominated flame retardants (BFRs)brominated flame retardants (BFRs) 1048698 1048698 dieseldiesel 1048698 1048698 dioxindioxin 1048698 1048698 formaldehydeformaldehyde 1048698 1048698 leadlead 1048698 1048698 mercurymercury home amp garden pesticideshome amp garden pesticides 1048698 1048698 phthalatesphthalates

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

A 52 yr-old pt co increasing tremor A 52 yr-old pt co increasing tremor On PE the tremor is pill-rolling and On PE the tremor is pill-rolling and resolves with intention +Romberg resolves with intention +Romberg sign unstable tandem gaitsign unstable tandem gait

You make a preliminary diagnosis of You make a preliminary diagnosis of early Parkinsonrsquos diseaseearly Parkinsonrsquos disease

Wife mentions reading about Wife mentions reading about environmental links to PD pt is a environmental links to PD pt is a farmer and has used pesticides for farmer and has used pesticides for years Could this be related to his years Could this be related to his diseasedisease

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

Paraquat rotenone organophosphates Paraquat rotenone organophosphates dieldrin and fungicides maneb amp dieldrin and fungicides maneb amp mancozeb implicatedmancozeb implicated

MPTP a designer heroin-like drug MPTP a designer heroin-like drug causes Parkinsonian syndrome in causes Parkinsonian syndrome in addictsaddicts

Higher incidence in industrialized Higher incidence in industrialized countries greatest risk in rural countries greatest risk in rural areasfarms prolonged pesticide useareasfarms prolonged pesticide use

Case control studies herbicide or Case control studies herbicide or insecticide exposure 3-4x likelyinsecticide exposure 3-4x likely

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

2005 Brown T et al Meta-analysis 2005 Brown T et al Meta-analysis of epidemi-ologic amp toxicologic of epidemi-ologic amp toxicologic studies since 1983 studies since 1983

Verified most of these links noting Verified most of these links noting limitations in study designs limitations in study designs

Conclusion ldquogeneric association btw Conclusion ldquogeneric association btw pesticide exposure amp PD exists but pesticide exposure amp PD exists but is insufficient tohellipconcludehellipa causal is insufficient tohellipconcludehellipa causal relationshiprdquo relationshiprdquo

Pesticides Genes amp PDPesticides Genes amp PD

Dr W Langston of Parkinsonrsquos Dr W Langston of Parkinsonrsquos Institute ldquoAccelerating Research on Institute ldquoAccelerating Research on Genes and Environment in Genes and Environment in Parkinsonrsquos Diseaserdquo (2005)Parkinsonrsquos Diseaserdquo (2005)

Two PD studies underway one in Two PD studies underway one in pesticide applicators other in two pesticide applicators other in two CA counties with known heavy CA counties with known heavy exposureexposure

Other Health Impacts of Other Health Impacts of PesticidesPesticides

ArrhythmiasArrhythmiasAsthmaAsthmaLymphomas Brain tumorsLymphomas Brain tumorsAbnormal sperm countsAbnormal sperm countsBirth defects amp developmental delaysBirth defects amp developmental delaysHyperactivity amp behavioral problemsHyperactivity amp behavioral problemsDecreased endurance amp coordinationDecreased endurance amp coordinationNeurocognitive problemsNeurocognitive problemsPeripheral neuropathiesPeripheral neuropathies

Pesticides a Persistent Pesticides a Persistent ProblemProblem

Major classesMajor classes insecticides fungicides insecticides fungicides herbicides rodenticidesherbicides rodenticides

1997 Market1997 Market US $119 billion World $37 US $119 billion World $37 billionbillion

HistoryHistory synthetic-new to humans amp synthetic-new to humans amp environment since 1940s gt800 licensed environment since 1940s gt800 licensed ldquoactiverdquo ingredientsldquoactiverdquo ingredients

Manufacturers Manufacturers Bayer Aventis other drug Bayer Aventis other drug coco

Inherent toxicityInherent toxicity 140 pesticides considered 140 pesticides considered neurotoxic 37 are used on food ampor feedneurotoxic 37 are used on food ampor feed

Insecticide Sites of Insecticide Sites of ActionAction

Enzymes

Axonal Membranes

Ions (Na+ K+ Ca++ Cl-)

Enzymes

Neurotransmitters

Organochlorines

Pyrethroids

Casarett and Doullrsquos Toxicology The Basic Science of Poisons 5th Edition Ed Klaassen CD

McGraw-Hill New York 1996 P 649

Organophosphorus and

Carbamate Esters

Organophosphate PesticidesOrganophosphate PesticidesOccurrence and distribution in surface amp

ground water of the United States 1992-97

httpgawaterusgsgovpublicationsabstractsofr00-187html

Background Pesticide Background Pesticide Exposures WidespreadExposures Widespread

Reported useReported use 98 of families 80 during 98 of families 80 during pregnancypregnancy

In HumansIn Humans detectable chlorpyrifos detectable chlorpyrifos metabolites in 92 of childrenrsquos 82 of metabolites in 92 of childrenrsquos 82 of adultsrsquo urine samplesadultsrsquo urine samples

In FoodIn Food residues of at least one pesticide on residues of at least one pesticide on 72 fruits amp vegetables72 fruits amp vegetables

In HomesIn Homes 3 to 9 pesticide residues found3 to 9 pesticide residues found

In AirIn Air indoor levels 10-100X higher than indoor levels 10-100X higher than outdooroutdoor

In WaterIn Water gt90 stream samples 50 of gt90 stream samples 50 of wellswells

Sources of PesticidesSources of Pesticides

Household uses lawn amp garden Household uses lawn amp garden sprays exterminators flea collarssprays exterminators flea collars

Household dust (tracking in on shoes)Household dust (tracking in on shoes)

Public schools hospitals parks Public schools hospitals parks childcare facilitieschildcare facilities

Agricultural uses amp workersrsquo clothesAgricultural uses amp workersrsquo clothes

Non-organic foodsNon-organic foods

Breast milkBreast milk

Strategies to Reduces Strategies to Reduces Exposure to Home amp Garden Exposure to Home amp Garden

Pesticides in OregonPesticides in OregonPolicy SolutionsPolicy Solutions OR pesticide use reporting system OR pesticide use reporting system

(1999) finally funded 2005(1999) finally funded 2005 Educate homeowners re nontoxic Educate homeowners re nontoxic

options options Enc pet owners to use flea combs and Enc pet owners to use flea combs and

vacuuming to control fleasvacuuming to control fleas Enc public places to use Integrated Enc public places to use Integrated

Pest Management (IPM) ie Pesticide Pest Management (IPM) ie Pesticide Free ParksFree Parks

What YOU Can Do about What YOU Can Do about PesticidesPesticides

Advise PatientsAdvise Patients Regularly dustRegularly dust Use Integrated Pest Management Use Integrated Pest Management Cleanremove shoes outsideCleanremove shoes outside Keep contaminated clothes separateKeep contaminated clothes separate Buy sustainably grown foodBuy sustainably grown food Store food in secure nontoxic Store food in secure nontoxic

containerscontainers

Mercury amp Women of Mercury amp Women of Childbearing AgeChildbearing Age

A 32 yo G0P0 woman of A 32 yo G0P0 woman of childbearing age (WCBA) childbearing age (WCBA) presents for annual PE presents for annual PE

PMH negativePMH negative

Social hx husband is Social hx husband is recreational fisherman recreational fisherman

Contemplating pregnancy Contemplating pregnancy

Should she avoid fish Should she avoid fish because of mercury risks because of mercury risks to the fetusto the fetus

Mercury amp WCBAMercury amp WCBA

gt10gt10 of WCBA exceed safe limit of of WCBA exceed safe limit of 1ugkgday1ugkgday

5050 of women of women who eat fishwho eat fish exceed exceed limitlimit

5757 of WCBA have Hg levels of WCBA have Hg levels concerning for adverse effects concerning for adverse effects (CDC (CDC Natrsquol Report 0705Natrsquol Report 0705))

Higher risk Higher risk 300 000 childrenyear 300 000 childrenyear subsistence fishers immigrants subsistence fishers immigrants Native AmericansNative Americans

Mercury amp WCBAMercury amp WCBA

Hg enters tissues variable excretionHg enters tissues variable excretion Breast Milk PCBs DDT amp other Breast Milk PCBs DDT amp other

pesticides dioxins dibenzofurans pesticides dioxins dibenzofurans toxic flame retardants amp heavy toxic flame retardants amp heavy metals (Pb amp Hg) metals (Pb amp Hg)

No bio-accumulation in milk but No bio-accumulation in milk but levels in fish-eaters may exceed levels in fish-eaters may exceed unexposed women by 100x unexposed women by 100x

Scientific evidence indicates Scientific evidence indicates advantages of breast-feeding advantages of breast-feeding outweigh riskshellipoutweigh riskshellip

Neuro Effects of MercuryNeuro Effects of Mercury

Cerebral palsyCerebral palsy MRDDMRDD disequilibrium ataxiadisequilibrium ataxia hearing lossdeafnesshearing lossdeafness visual visual

impairmentblindnessimpairmentblindness peripheral neuropathyperipheral neuropathy parasthesiasparasthesias tremors seizures tremors seizures abnl reflexes amp muscle toneabnl reflexes amp muscle tone Psychiatric disturbances Psychiatric disturbances

Mercury a Persistent Mercury a Persistent ProblemProblem

PoisoningsPoisonings Minamata 1950s amp Iraq Minamata 1950s amp Iraq 19711971

Nationally ~Nationally ~160 tons of Hg annually160 tons of Hg annually In OregonIn Oregon ~ ~4500 lbs annually4500 lbs annually Lack of regulationLack of regulation In OR 10 facilities In OR 10 facilities

report Hg release-none has a permit or is report Hg release-none has a permit or is required to monitor emissions by staterequired to monitor emissions by state

Fish AdvisoriesFish Advisories in 2004 45 states had in 2004 45 states had gt2000 warnings Oregon lists advisories gt2000 warnings Oregon lists advisories for 12 water bodies inc Willamette for 12 water bodies inc Willamette

Atmospheric HgAtmospheric Hg

The Mercury CycleThe Mercury Cycle

MercuryMercuryDeclining Threshold of Declining Threshold of

HarmHarm

2000199019801970001

01

1

10

100

YEAR

Level associated with harmful effectRegulatory standard (maximum safe exposure or high end exposure from allowed fish contamination)

FDA WHO

EPA

ATSDR

DA

ILY

IN

TA

KE

(mic

rogr

ams

kg

day

Hg)

Sources of MercurySources of MercuryIndustrial emissions Industrial emissions

coal fired plantscoal fired plantsMunicipal amp medical Municipal amp medical

waste incineratorswaste incineratorsAbandoned Hg amp gold Abandoned Hg amp gold

minesminesNatural off-gassing Natural off-gassing Dental amalgamsDental amalgamsBioaccumulation in Bioaccumulation in

foods esp fishfoods esp fishOld thermometers BP Old thermometers BP

cuffs amp auto cuffs amp auto switchesswitches

Strategies to Reduce Strategies to Reduce Mercury Pollution in Mercury Pollution in

OregonOregonPolicy SolutionsPolicy Solutions Mercury Solutions Act of 2001Mercury Solutions Act of 2001 Ensure safe collection amp recyclingEnsure safe collection amp recycling Clean up abandoned mines and Clean up abandoned mines and

SuperfundsSuperfunds Reduce Hg emissions from health Reduce Hg emissions from health

care facilitiescare facilities Inc Hg in applicable DEQ air amp Inc Hg in applicable DEQ air amp

water permitswater permits Coal burning power plant Boardman Coal burning power plant Boardman

OR OR Implement OR Executive OrderImplement OR Executive Order

What YOU Can Do about What YOU Can Do about MercuryMercury

Advise PatientsAdvise Patients Provide Provide An Expectant Motherrsquos Guide to An Expectant Motherrsquos Guide to

Eating Fish in Oregon (DHS) Eating Fish in Oregon (DHS) in waiting in waiting roomsrooms

Rec WCBA and children avoid fish wHgRec WCBA and children avoid fish wHg Enc WCBA to consume low-fat dietEnc WCBA to consume low-fat diet Recycle old Hg thermometers Recycle old Hg thermometers

thermostats amp fluorescent light tubesthermostats amp fluorescent light tubes Have car checked for Hg switches at Have car checked for Hg switches at

participating auto shop (free participating auto shop (free replacement)replacement)

Use digital thermometers amp thermostatsUse digital thermometers amp thermostats

SummarySummary Chronic Diseases are prevalent Toxic Chronic Diseases are prevalent Toxic

exposures are possible exposures are possible preventablepreventable contributorscontributors

Pesticides amp risk of Parkinsonrsquos and Mercury Pesticides amp risk of Parkinsonrsquos and Mercury risks to WCBA are more understood than most risks to WCBA are more understood than most toxins and other chronic diseasestoxins and other chronic diseases

Apparent toxicity at high doses should be a Apparent toxicity at high doses should be a red flag for possible harm from low dose red flag for possible harm from low dose chronic exposureschronic exposures

Since ldquoproofrdquo of harm materializes slowly Since ldquoproofrdquo of harm materializes slowly generations are at risk and may be harmed generations are at risk and may be harmed before adequate regulatory response occursbefore adequate regulatory response occurs

Kaiser amp HCWHh2eKaiser amp HCWHh2e

Clean Diesel Hospital Zones ProjectClean Diesel Hospital Zones Project Healthy Food in Healthcare InitiativeHealthy Food in Healthcare Initiative Green Building PVC and DEHP free Green Building PVC and DEHP free

NICU NICU Environmentally preferable purchasing Environmentally preferable purchasing

policypolicy Making Medicine Mercury Free Award Making Medicine Mercury Free Award h2e Environmental Leadership Award h2e Environmental Leadership Award

20022002

What Can You DoWhat Can You Do

Be aware of environmental toxins amp Be aware of environmental toxins amp their possible links to chronic diseasestheir possible links to chronic diseases

Provide advice amp education on Provide advice amp education on prevention andor minimizing prevention andor minimizing exposures or refer appropriately exposures or refer appropriately

Incorporate environmental questions Incorporate environmental questions into clinical historyinto clinical history

Advocate Advocate wwwenvirohealthactionorgwwwenvirohealthactionorg

Local AdvocacyLocal Advocacy Oregon Environmental CouncilOregon Environmental Council wwwoeconlineorgwwwoeconlineorg Oregon Collaborative on Health amp Oregon Collaborative on Health amp

EnvironmentEnvironment Healthy Environment ForumsHealthy Environment Forums Oregon Center for Environmental HealthOregon Center for Environmental Health wwworegon-healthorgwwworegon-healthorg Healthcare without HarmHealthcare without Harm Hospitals for Healthy Environment (h2e)Hospitals for Healthy Environment (h2e) Oregon PSROregon PSR wwworegonpsrorgwwworegonpsrorg Environmental Health-In Harmrsquos Way Environmental Health-In Harmrsquos Way

Healthy People 2010Healthy People 2010

National objectivesNational objectives Most significant Most significant

preventable preventable threats to health threats to health amp goals to reduce amp goals to reduce themthem

Includes Includes environmental environmental health objectiveshealth objectives

Providers role in Providers role in preventionprevention

Healthy People 2010 Toxic Healthy People 2010 Toxic WastesWastes

Lower elevated blood lead levels to Lower elevated blood lead levels to 11

Minimize risks from hazardous sitesMinimize risks from hazardous sites Reduce pesticide exposuresReduce pesticide exposures Reduce toxic pollutants produced Reduce toxic pollutants produced

disposed of treated or used for disposed of treated or used for energy recoveryenergy recovery

Increase recycling of solid waste to Increase recycling of solid waste to 3838

State of Knowledge Our State of Knowledge Our Chemical EnvironmentChemical Environment

gt80000 chemicals in gt80000 chemicals in Federal inventoryFederal inventory

2000 to 3000 NEW 2000 to 3000 NEW chemicals per yearchemicals per year

gt4 billion lbs released gt4 billion lbs released into environment yearly into environment yearly 72 million lbs of 72 million lbs of recognized carcinogens recognized carcinogens

Basic Screening Basic Screening Information Data Set Information Data Set (SIDS) avg $205000 per (SIDS) avg $205000 per chemicalchemical

Hazard Data - Chemicals Hazard Data - Chemicals Produced Produced

gt 1 Million PoundsYear gt 1 Million PoundsYear

0 10 20 30 40 50 60 70 80 90 100

Percentage Tested

Acute Toxicity

Environmental Fate

Ecotoxicity

Mutagenicity

Chronic Toxicity

ReproductiveToxicity

Full Set of BasicToxicity Tests

Medical WasteMedical Waste

6000 US hospitals~2 million 6000 US hospitals~2 million tons waste per year tons waste per year

Clinics and doctorsrsquo offices add 700000 Clinics and doctorsrsquo offices add 700000 tonstons

EPA regulations weak-HCWHh2eEPA regulations weak-HCWHh2e 850000 tons incinerated850000 tons incinerated

Pollutants inc dioxin Hg cadmium Pollutants inc dioxin Hg cadmium and Pband Pb

Segregation amp alternatives to Segregation amp alternatives to incineration incineration would cost 93 would cost 93 centspatientdaycentspatientday

Our Chemical EnvironmentOur Chemical Environment

1305 Superfund sites1305 Superfund sites 25002500 are are eligible eligible gt80kgt80k hazardous sites hazardous sites knownknown

~11 million people live within 1 mile~11 million people live within 1 mile ~25 live within 4 miles~25 live within 4 miles OR ranks 24OR ranks 24-12 Superfund sites-12 Superfund sites 3 in PDX3 in PDX Harbor Oil Portland Harbor Oil Portland

Harbor Harbor McCormick amp Baxter McCormick amp Baxter Creosoting Co Creosoting Co

Multnomah amp Washington CoMultnomah amp Washington CoShared Pollutants 2002Shared Pollutants 2002

Links to Disease Links to Disease

Methanol (gt240k lbs)Methanol (gt240k lbs)

StrongStrong ATN amp vision problems ATN amp vision problems

GoodGood Pancreatitis amp Pancreatitis amp Parkinsonrsquosmovement disorders Parkinsonrsquosmovement disorders

Ammonia (gt100k lbs)Ammonia (gt100k lbs)

StrongStrong Asthma acutechronic bronchitis Asthma acutechronic bronchitis olfactory disorders amp rhinitis olfactory disorders amp rhinitis

GoodGood Pulmonary edema Pulmonary edema

Links to Disease contLinks to Disease cont

Xylene (gt95k lbs) amp Toluene (gt83k lbs)Xylene (gt95k lbs) amp Toluene (gt83k lbs) GoodGood Scleroderma arrhythmias menstrual Scleroderma arrhythmias menstrual

do cognitive impairment hearing loss amp do cognitive impairment hearing loss amp fetal death (miscarriagestillbirth)fetal death (miscarriagestillbirth)

Glycol Ethers (gt20k lbs)Glycol Ethers (gt20k lbs) StrongStrong Reduced male fertility abnormal Reduced male fertility abnormal

sperm (morphology motility amp count) amp fetal sperm (morphology motility amp count) amp fetal death (miscarriagestillbirth) death (miscarriagestillbirth)

GoodGood ATN reduced female fertility general ATN reduced female fertility general congenital and craniofacial malformationscongenital and craniofacial malformations

National Report on Human National Report on Human Exposure to Environmental Exposure to Environmental

Chemicals Chemicals (CDC 705)(CDC 705)

Random selection from NHANES Random selection from NHANES surveysurvey

148 chemicals from 2001-2002 inc 148 chemicals from 2001-2002 inc data on 116 chemicals from 1999-data on 116 chemicals from 1999-20002000

Criteria for chemical inclusion Criteria for chemical inclusion wide exposure wide exposure serious health effects serious health effects adequate blood amp urine samples adequate blood amp urine samples efficacy of attempts to reduce efficacy of attempts to reduce

exposure exposure availability of reliable bio-monitoring availability of reliable bio-monitoring

methodmethod

CDC Report GoalsCDC Report Goals

Which chemicals are present amp Which chemicals are present amp concentrations concentrations

How many people have levels above How many people have levels above known toxicity thresholdsknown toxicity thresholds

Establish reference ranges Establish reference ranges Determine if levels are higher in at Determine if levels are higher in at

risk populations risk populations Track trends over time Track trends over time Set priorities for researchSet priorities for research

CDC Report HighlightsCDC Report Highlights

First time data for 38148 chemicalsFirst time data for 38148 chemicals BLL declining 44 of children early BLL declining 44 of children early

1990s 16 of children from 1999-1990s 16 of children from 1999-20022002

Hg in women of childbearing age Hg in women of childbearing age 57 have concerning levels57 have concerning levels

Pyrethroid insecticides (common Pyrethroid insecticides (common home use) 76 of populationhome use) 76 of population

Highlights contHighlights cont

Levels of 3 toxic pesticides- Levels of 3 toxic pesticides- Aldrin Dieldrin amp Endrin-very low Aldrin Dieldrin amp Endrin-very low

29 Dioxin-like compounds levels are 29 Dioxin-like compounds levels are declining declining

Cadmium 5 population gt20yrs age Cadmium 5 population gt20yrs age levels near toxic limit (kidney dz low levels near toxic limit (kidney dz low BMD)BMD)

Phthalates widespread higher in Phthalates widespread higher in women amp childrenwomen amp children

Limitations of Current DataLimitations of Current Data

Exposure to chemical mixtures Exposure to chemical mixtures common-research more complexcommon-research more complex

Data available for only minority Data available for only minority single agentssingle agents

Epidemiological amp animal studies Epidemiological amp animal studies often only data availableoften only data available

Result links btw Chronic Diseases amp Result links btw Chronic Diseases amp low dose chronic complex exposures low dose chronic complex exposures hard to ldquoproverdquohard to ldquoproverdquo

PROVEN HARM

PARTIALLY PROVEN

NOT YET RECOGNIZED

FOREVER UNRECOGNIZED

THE TOXIC ICEBERG________________________________________

Oregoniansrsquo HealthOregoniansrsquo Health12 CHEMICALS OF KEY CONCERN12 CHEMICALS OF KEY CONCERN 1048698 1048698 acroleinacrolein 1048698 1048698 benzenebenzene 1048698 1048698 benzo(a)pyrenebenzo(a)pyrene 1048698 1048698 bisphenol-Abisphenol-A 1048698 1048698 brominated flame retardants (BFRs)brominated flame retardants (BFRs) 1048698 1048698 dieseldiesel 1048698 1048698 dioxindioxin 1048698 1048698 formaldehydeformaldehyde 1048698 1048698 leadlead 1048698 1048698 mercurymercury home amp garden pesticideshome amp garden pesticides 1048698 1048698 phthalatesphthalates

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

A 52 yr-old pt co increasing tremor A 52 yr-old pt co increasing tremor On PE the tremor is pill-rolling and On PE the tremor is pill-rolling and resolves with intention +Romberg resolves with intention +Romberg sign unstable tandem gaitsign unstable tandem gait

You make a preliminary diagnosis of You make a preliminary diagnosis of early Parkinsonrsquos diseaseearly Parkinsonrsquos disease

Wife mentions reading about Wife mentions reading about environmental links to PD pt is a environmental links to PD pt is a farmer and has used pesticides for farmer and has used pesticides for years Could this be related to his years Could this be related to his diseasedisease

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

Paraquat rotenone organophosphates Paraquat rotenone organophosphates dieldrin and fungicides maneb amp dieldrin and fungicides maneb amp mancozeb implicatedmancozeb implicated

MPTP a designer heroin-like drug MPTP a designer heroin-like drug causes Parkinsonian syndrome in causes Parkinsonian syndrome in addictsaddicts

Higher incidence in industrialized Higher incidence in industrialized countries greatest risk in rural countries greatest risk in rural areasfarms prolonged pesticide useareasfarms prolonged pesticide use

Case control studies herbicide or Case control studies herbicide or insecticide exposure 3-4x likelyinsecticide exposure 3-4x likely

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

2005 Brown T et al Meta-analysis 2005 Brown T et al Meta-analysis of epidemi-ologic amp toxicologic of epidemi-ologic amp toxicologic studies since 1983 studies since 1983

Verified most of these links noting Verified most of these links noting limitations in study designs limitations in study designs

Conclusion ldquogeneric association btw Conclusion ldquogeneric association btw pesticide exposure amp PD exists but pesticide exposure amp PD exists but is insufficient tohellipconcludehellipa causal is insufficient tohellipconcludehellipa causal relationshiprdquo relationshiprdquo

Pesticides Genes amp PDPesticides Genes amp PD

Dr W Langston of Parkinsonrsquos Dr W Langston of Parkinsonrsquos Institute ldquoAccelerating Research on Institute ldquoAccelerating Research on Genes and Environment in Genes and Environment in Parkinsonrsquos Diseaserdquo (2005)Parkinsonrsquos Diseaserdquo (2005)

Two PD studies underway one in Two PD studies underway one in pesticide applicators other in two pesticide applicators other in two CA counties with known heavy CA counties with known heavy exposureexposure

Other Health Impacts of Other Health Impacts of PesticidesPesticides

ArrhythmiasArrhythmiasAsthmaAsthmaLymphomas Brain tumorsLymphomas Brain tumorsAbnormal sperm countsAbnormal sperm countsBirth defects amp developmental delaysBirth defects amp developmental delaysHyperactivity amp behavioral problemsHyperactivity amp behavioral problemsDecreased endurance amp coordinationDecreased endurance amp coordinationNeurocognitive problemsNeurocognitive problemsPeripheral neuropathiesPeripheral neuropathies

Pesticides a Persistent Pesticides a Persistent ProblemProblem

Major classesMajor classes insecticides fungicides insecticides fungicides herbicides rodenticidesherbicides rodenticides

1997 Market1997 Market US $119 billion World $37 US $119 billion World $37 billionbillion

HistoryHistory synthetic-new to humans amp synthetic-new to humans amp environment since 1940s gt800 licensed environment since 1940s gt800 licensed ldquoactiverdquo ingredientsldquoactiverdquo ingredients

Manufacturers Manufacturers Bayer Aventis other drug Bayer Aventis other drug coco

Inherent toxicityInherent toxicity 140 pesticides considered 140 pesticides considered neurotoxic 37 are used on food ampor feedneurotoxic 37 are used on food ampor feed

Insecticide Sites of Insecticide Sites of ActionAction

Enzymes

Axonal Membranes

Ions (Na+ K+ Ca++ Cl-)

Enzymes

Neurotransmitters

Organochlorines

Pyrethroids

Casarett and Doullrsquos Toxicology The Basic Science of Poisons 5th Edition Ed Klaassen CD

McGraw-Hill New York 1996 P 649

Organophosphorus and

Carbamate Esters

Organophosphate PesticidesOrganophosphate PesticidesOccurrence and distribution in surface amp

ground water of the United States 1992-97

httpgawaterusgsgovpublicationsabstractsofr00-187html

Background Pesticide Background Pesticide Exposures WidespreadExposures Widespread

Reported useReported use 98 of families 80 during 98 of families 80 during pregnancypregnancy

In HumansIn Humans detectable chlorpyrifos detectable chlorpyrifos metabolites in 92 of childrenrsquos 82 of metabolites in 92 of childrenrsquos 82 of adultsrsquo urine samplesadultsrsquo urine samples

In FoodIn Food residues of at least one pesticide on residues of at least one pesticide on 72 fruits amp vegetables72 fruits amp vegetables

In HomesIn Homes 3 to 9 pesticide residues found3 to 9 pesticide residues found

In AirIn Air indoor levels 10-100X higher than indoor levels 10-100X higher than outdooroutdoor

In WaterIn Water gt90 stream samples 50 of gt90 stream samples 50 of wellswells

Sources of PesticidesSources of Pesticides

Household uses lawn amp garden Household uses lawn amp garden sprays exterminators flea collarssprays exterminators flea collars

Household dust (tracking in on shoes)Household dust (tracking in on shoes)

Public schools hospitals parks Public schools hospitals parks childcare facilitieschildcare facilities

Agricultural uses amp workersrsquo clothesAgricultural uses amp workersrsquo clothes

Non-organic foodsNon-organic foods

Breast milkBreast milk

Strategies to Reduces Strategies to Reduces Exposure to Home amp Garden Exposure to Home amp Garden

Pesticides in OregonPesticides in OregonPolicy SolutionsPolicy Solutions OR pesticide use reporting system OR pesticide use reporting system

(1999) finally funded 2005(1999) finally funded 2005 Educate homeowners re nontoxic Educate homeowners re nontoxic

options options Enc pet owners to use flea combs and Enc pet owners to use flea combs and

vacuuming to control fleasvacuuming to control fleas Enc public places to use Integrated Enc public places to use Integrated

Pest Management (IPM) ie Pesticide Pest Management (IPM) ie Pesticide Free ParksFree Parks

What YOU Can Do about What YOU Can Do about PesticidesPesticides

Advise PatientsAdvise Patients Regularly dustRegularly dust Use Integrated Pest Management Use Integrated Pest Management Cleanremove shoes outsideCleanremove shoes outside Keep contaminated clothes separateKeep contaminated clothes separate Buy sustainably grown foodBuy sustainably grown food Store food in secure nontoxic Store food in secure nontoxic

containerscontainers

Mercury amp Women of Mercury amp Women of Childbearing AgeChildbearing Age

A 32 yo G0P0 woman of A 32 yo G0P0 woman of childbearing age (WCBA) childbearing age (WCBA) presents for annual PE presents for annual PE

PMH negativePMH negative

Social hx husband is Social hx husband is recreational fisherman recreational fisherman

Contemplating pregnancy Contemplating pregnancy

Should she avoid fish Should she avoid fish because of mercury risks because of mercury risks to the fetusto the fetus

Mercury amp WCBAMercury amp WCBA

gt10gt10 of WCBA exceed safe limit of of WCBA exceed safe limit of 1ugkgday1ugkgday

5050 of women of women who eat fishwho eat fish exceed exceed limitlimit

5757 of WCBA have Hg levels of WCBA have Hg levels concerning for adverse effects concerning for adverse effects (CDC (CDC Natrsquol Report 0705Natrsquol Report 0705))

Higher risk Higher risk 300 000 childrenyear 300 000 childrenyear subsistence fishers immigrants subsistence fishers immigrants Native AmericansNative Americans

Mercury amp WCBAMercury amp WCBA

Hg enters tissues variable excretionHg enters tissues variable excretion Breast Milk PCBs DDT amp other Breast Milk PCBs DDT amp other

pesticides dioxins dibenzofurans pesticides dioxins dibenzofurans toxic flame retardants amp heavy toxic flame retardants amp heavy metals (Pb amp Hg) metals (Pb amp Hg)

No bio-accumulation in milk but No bio-accumulation in milk but levels in fish-eaters may exceed levels in fish-eaters may exceed unexposed women by 100x unexposed women by 100x

Scientific evidence indicates Scientific evidence indicates advantages of breast-feeding advantages of breast-feeding outweigh riskshellipoutweigh riskshellip

Neuro Effects of MercuryNeuro Effects of Mercury

Cerebral palsyCerebral palsy MRDDMRDD disequilibrium ataxiadisequilibrium ataxia hearing lossdeafnesshearing lossdeafness visual visual

impairmentblindnessimpairmentblindness peripheral neuropathyperipheral neuropathy parasthesiasparasthesias tremors seizures tremors seizures abnl reflexes amp muscle toneabnl reflexes amp muscle tone Psychiatric disturbances Psychiatric disturbances

Mercury a Persistent Mercury a Persistent ProblemProblem

PoisoningsPoisonings Minamata 1950s amp Iraq Minamata 1950s amp Iraq 19711971

Nationally ~Nationally ~160 tons of Hg annually160 tons of Hg annually In OregonIn Oregon ~ ~4500 lbs annually4500 lbs annually Lack of regulationLack of regulation In OR 10 facilities In OR 10 facilities

report Hg release-none has a permit or is report Hg release-none has a permit or is required to monitor emissions by staterequired to monitor emissions by state

Fish AdvisoriesFish Advisories in 2004 45 states had in 2004 45 states had gt2000 warnings Oregon lists advisories gt2000 warnings Oregon lists advisories for 12 water bodies inc Willamette for 12 water bodies inc Willamette

Atmospheric HgAtmospheric Hg

The Mercury CycleThe Mercury Cycle

MercuryMercuryDeclining Threshold of Declining Threshold of

HarmHarm

2000199019801970001

01

1

10

100

YEAR

Level associated with harmful effectRegulatory standard (maximum safe exposure or high end exposure from allowed fish contamination)

FDA WHO

EPA

ATSDR

DA

ILY

IN

TA

KE

(mic

rogr

ams

kg

day

Hg)

Sources of MercurySources of MercuryIndustrial emissions Industrial emissions

coal fired plantscoal fired plantsMunicipal amp medical Municipal amp medical

waste incineratorswaste incineratorsAbandoned Hg amp gold Abandoned Hg amp gold

minesminesNatural off-gassing Natural off-gassing Dental amalgamsDental amalgamsBioaccumulation in Bioaccumulation in

foods esp fishfoods esp fishOld thermometers BP Old thermometers BP

cuffs amp auto cuffs amp auto switchesswitches

Strategies to Reduce Strategies to Reduce Mercury Pollution in Mercury Pollution in

OregonOregonPolicy SolutionsPolicy Solutions Mercury Solutions Act of 2001Mercury Solutions Act of 2001 Ensure safe collection amp recyclingEnsure safe collection amp recycling Clean up abandoned mines and Clean up abandoned mines and

SuperfundsSuperfunds Reduce Hg emissions from health Reduce Hg emissions from health

care facilitiescare facilities Inc Hg in applicable DEQ air amp Inc Hg in applicable DEQ air amp

water permitswater permits Coal burning power plant Boardman Coal burning power plant Boardman

OR OR Implement OR Executive OrderImplement OR Executive Order

What YOU Can Do about What YOU Can Do about MercuryMercury

Advise PatientsAdvise Patients Provide Provide An Expectant Motherrsquos Guide to An Expectant Motherrsquos Guide to

Eating Fish in Oregon (DHS) Eating Fish in Oregon (DHS) in waiting in waiting roomsrooms

Rec WCBA and children avoid fish wHgRec WCBA and children avoid fish wHg Enc WCBA to consume low-fat dietEnc WCBA to consume low-fat diet Recycle old Hg thermometers Recycle old Hg thermometers

thermostats amp fluorescent light tubesthermostats amp fluorescent light tubes Have car checked for Hg switches at Have car checked for Hg switches at

participating auto shop (free participating auto shop (free replacement)replacement)

Use digital thermometers amp thermostatsUse digital thermometers amp thermostats

SummarySummary Chronic Diseases are prevalent Toxic Chronic Diseases are prevalent Toxic

exposures are possible exposures are possible preventablepreventable contributorscontributors

Pesticides amp risk of Parkinsonrsquos and Mercury Pesticides amp risk of Parkinsonrsquos and Mercury risks to WCBA are more understood than most risks to WCBA are more understood than most toxins and other chronic diseasestoxins and other chronic diseases

Apparent toxicity at high doses should be a Apparent toxicity at high doses should be a red flag for possible harm from low dose red flag for possible harm from low dose chronic exposureschronic exposures

Since ldquoproofrdquo of harm materializes slowly Since ldquoproofrdquo of harm materializes slowly generations are at risk and may be harmed generations are at risk and may be harmed before adequate regulatory response occursbefore adequate regulatory response occurs

Kaiser amp HCWHh2eKaiser amp HCWHh2e

Clean Diesel Hospital Zones ProjectClean Diesel Hospital Zones Project Healthy Food in Healthcare InitiativeHealthy Food in Healthcare Initiative Green Building PVC and DEHP free Green Building PVC and DEHP free

NICU NICU Environmentally preferable purchasing Environmentally preferable purchasing

policypolicy Making Medicine Mercury Free Award Making Medicine Mercury Free Award h2e Environmental Leadership Award h2e Environmental Leadership Award

20022002

What Can You DoWhat Can You Do

Be aware of environmental toxins amp Be aware of environmental toxins amp their possible links to chronic diseasestheir possible links to chronic diseases

Provide advice amp education on Provide advice amp education on prevention andor minimizing prevention andor minimizing exposures or refer appropriately exposures or refer appropriately

Incorporate environmental questions Incorporate environmental questions into clinical historyinto clinical history

Advocate Advocate wwwenvirohealthactionorgwwwenvirohealthactionorg

Local AdvocacyLocal Advocacy Oregon Environmental CouncilOregon Environmental Council wwwoeconlineorgwwwoeconlineorg Oregon Collaborative on Health amp Oregon Collaborative on Health amp

EnvironmentEnvironment Healthy Environment ForumsHealthy Environment Forums Oregon Center for Environmental HealthOregon Center for Environmental Health wwworegon-healthorgwwworegon-healthorg Healthcare without HarmHealthcare without Harm Hospitals for Healthy Environment (h2e)Hospitals for Healthy Environment (h2e) Oregon PSROregon PSR wwworegonpsrorgwwworegonpsrorg Environmental Health-In Harmrsquos Way Environmental Health-In Harmrsquos Way

Healthy People 2010 Toxic Healthy People 2010 Toxic WastesWastes

Lower elevated blood lead levels to Lower elevated blood lead levels to 11

Minimize risks from hazardous sitesMinimize risks from hazardous sites Reduce pesticide exposuresReduce pesticide exposures Reduce toxic pollutants produced Reduce toxic pollutants produced

disposed of treated or used for disposed of treated or used for energy recoveryenergy recovery

Increase recycling of solid waste to Increase recycling of solid waste to 3838

State of Knowledge Our State of Knowledge Our Chemical EnvironmentChemical Environment

gt80000 chemicals in gt80000 chemicals in Federal inventoryFederal inventory

2000 to 3000 NEW 2000 to 3000 NEW chemicals per yearchemicals per year

gt4 billion lbs released gt4 billion lbs released into environment yearly into environment yearly 72 million lbs of 72 million lbs of recognized carcinogens recognized carcinogens

Basic Screening Basic Screening Information Data Set Information Data Set (SIDS) avg $205000 per (SIDS) avg $205000 per chemicalchemical

Hazard Data - Chemicals Hazard Data - Chemicals Produced Produced

gt 1 Million PoundsYear gt 1 Million PoundsYear

0 10 20 30 40 50 60 70 80 90 100

Percentage Tested

Acute Toxicity

Environmental Fate

Ecotoxicity

Mutagenicity

Chronic Toxicity

ReproductiveToxicity

Full Set of BasicToxicity Tests

Medical WasteMedical Waste

6000 US hospitals~2 million 6000 US hospitals~2 million tons waste per year tons waste per year

Clinics and doctorsrsquo offices add 700000 Clinics and doctorsrsquo offices add 700000 tonstons

EPA regulations weak-HCWHh2eEPA regulations weak-HCWHh2e 850000 tons incinerated850000 tons incinerated

Pollutants inc dioxin Hg cadmium Pollutants inc dioxin Hg cadmium and Pband Pb

Segregation amp alternatives to Segregation amp alternatives to incineration incineration would cost 93 would cost 93 centspatientdaycentspatientday

Our Chemical EnvironmentOur Chemical Environment

1305 Superfund sites1305 Superfund sites 25002500 are are eligible eligible gt80kgt80k hazardous sites hazardous sites knownknown

~11 million people live within 1 mile~11 million people live within 1 mile ~25 live within 4 miles~25 live within 4 miles OR ranks 24OR ranks 24-12 Superfund sites-12 Superfund sites 3 in PDX3 in PDX Harbor Oil Portland Harbor Oil Portland

Harbor Harbor McCormick amp Baxter McCormick amp Baxter Creosoting Co Creosoting Co

Multnomah amp Washington CoMultnomah amp Washington CoShared Pollutants 2002Shared Pollutants 2002

Links to Disease Links to Disease

Methanol (gt240k lbs)Methanol (gt240k lbs)

StrongStrong ATN amp vision problems ATN amp vision problems

GoodGood Pancreatitis amp Pancreatitis amp Parkinsonrsquosmovement disorders Parkinsonrsquosmovement disorders

Ammonia (gt100k lbs)Ammonia (gt100k lbs)

StrongStrong Asthma acutechronic bronchitis Asthma acutechronic bronchitis olfactory disorders amp rhinitis olfactory disorders amp rhinitis

GoodGood Pulmonary edema Pulmonary edema

Links to Disease contLinks to Disease cont

Xylene (gt95k lbs) amp Toluene (gt83k lbs)Xylene (gt95k lbs) amp Toluene (gt83k lbs) GoodGood Scleroderma arrhythmias menstrual Scleroderma arrhythmias menstrual

do cognitive impairment hearing loss amp do cognitive impairment hearing loss amp fetal death (miscarriagestillbirth)fetal death (miscarriagestillbirth)

Glycol Ethers (gt20k lbs)Glycol Ethers (gt20k lbs) StrongStrong Reduced male fertility abnormal Reduced male fertility abnormal

sperm (morphology motility amp count) amp fetal sperm (morphology motility amp count) amp fetal death (miscarriagestillbirth) death (miscarriagestillbirth)

GoodGood ATN reduced female fertility general ATN reduced female fertility general congenital and craniofacial malformationscongenital and craniofacial malformations

National Report on Human National Report on Human Exposure to Environmental Exposure to Environmental

Chemicals Chemicals (CDC 705)(CDC 705)

Random selection from NHANES Random selection from NHANES surveysurvey

148 chemicals from 2001-2002 inc 148 chemicals from 2001-2002 inc data on 116 chemicals from 1999-data on 116 chemicals from 1999-20002000

Criteria for chemical inclusion Criteria for chemical inclusion wide exposure wide exposure serious health effects serious health effects adequate blood amp urine samples adequate blood amp urine samples efficacy of attempts to reduce efficacy of attempts to reduce

exposure exposure availability of reliable bio-monitoring availability of reliable bio-monitoring

methodmethod

CDC Report GoalsCDC Report Goals

Which chemicals are present amp Which chemicals are present amp concentrations concentrations

How many people have levels above How many people have levels above known toxicity thresholdsknown toxicity thresholds

Establish reference ranges Establish reference ranges Determine if levels are higher in at Determine if levels are higher in at

risk populations risk populations Track trends over time Track trends over time Set priorities for researchSet priorities for research

CDC Report HighlightsCDC Report Highlights

First time data for 38148 chemicalsFirst time data for 38148 chemicals BLL declining 44 of children early BLL declining 44 of children early

1990s 16 of children from 1999-1990s 16 of children from 1999-20022002

Hg in women of childbearing age Hg in women of childbearing age 57 have concerning levels57 have concerning levels

Pyrethroid insecticides (common Pyrethroid insecticides (common home use) 76 of populationhome use) 76 of population

Highlights contHighlights cont

Levels of 3 toxic pesticides- Levels of 3 toxic pesticides- Aldrin Dieldrin amp Endrin-very low Aldrin Dieldrin amp Endrin-very low

29 Dioxin-like compounds levels are 29 Dioxin-like compounds levels are declining declining

Cadmium 5 population gt20yrs age Cadmium 5 population gt20yrs age levels near toxic limit (kidney dz low levels near toxic limit (kidney dz low BMD)BMD)

Phthalates widespread higher in Phthalates widespread higher in women amp childrenwomen amp children

Limitations of Current DataLimitations of Current Data

Exposure to chemical mixtures Exposure to chemical mixtures common-research more complexcommon-research more complex

Data available for only minority Data available for only minority single agentssingle agents

Epidemiological amp animal studies Epidemiological amp animal studies often only data availableoften only data available

Result links btw Chronic Diseases amp Result links btw Chronic Diseases amp low dose chronic complex exposures low dose chronic complex exposures hard to ldquoproverdquohard to ldquoproverdquo

PROVEN HARM

PARTIALLY PROVEN

NOT YET RECOGNIZED

FOREVER UNRECOGNIZED

THE TOXIC ICEBERG________________________________________

Oregoniansrsquo HealthOregoniansrsquo Health12 CHEMICALS OF KEY CONCERN12 CHEMICALS OF KEY CONCERN 1048698 1048698 acroleinacrolein 1048698 1048698 benzenebenzene 1048698 1048698 benzo(a)pyrenebenzo(a)pyrene 1048698 1048698 bisphenol-Abisphenol-A 1048698 1048698 brominated flame retardants (BFRs)brominated flame retardants (BFRs) 1048698 1048698 dieseldiesel 1048698 1048698 dioxindioxin 1048698 1048698 formaldehydeformaldehyde 1048698 1048698 leadlead 1048698 1048698 mercurymercury home amp garden pesticideshome amp garden pesticides 1048698 1048698 phthalatesphthalates

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

A 52 yr-old pt co increasing tremor A 52 yr-old pt co increasing tremor On PE the tremor is pill-rolling and On PE the tremor is pill-rolling and resolves with intention +Romberg resolves with intention +Romberg sign unstable tandem gaitsign unstable tandem gait

You make a preliminary diagnosis of You make a preliminary diagnosis of early Parkinsonrsquos diseaseearly Parkinsonrsquos disease

Wife mentions reading about Wife mentions reading about environmental links to PD pt is a environmental links to PD pt is a farmer and has used pesticides for farmer and has used pesticides for years Could this be related to his years Could this be related to his diseasedisease

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

Paraquat rotenone organophosphates Paraquat rotenone organophosphates dieldrin and fungicides maneb amp dieldrin and fungicides maneb amp mancozeb implicatedmancozeb implicated

MPTP a designer heroin-like drug MPTP a designer heroin-like drug causes Parkinsonian syndrome in causes Parkinsonian syndrome in addictsaddicts

Higher incidence in industrialized Higher incidence in industrialized countries greatest risk in rural countries greatest risk in rural areasfarms prolonged pesticide useareasfarms prolonged pesticide use

Case control studies herbicide or Case control studies herbicide or insecticide exposure 3-4x likelyinsecticide exposure 3-4x likely

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

2005 Brown T et al Meta-analysis 2005 Brown T et al Meta-analysis of epidemi-ologic amp toxicologic of epidemi-ologic amp toxicologic studies since 1983 studies since 1983

Verified most of these links noting Verified most of these links noting limitations in study designs limitations in study designs

Conclusion ldquogeneric association btw Conclusion ldquogeneric association btw pesticide exposure amp PD exists but pesticide exposure amp PD exists but is insufficient tohellipconcludehellipa causal is insufficient tohellipconcludehellipa causal relationshiprdquo relationshiprdquo

Pesticides Genes amp PDPesticides Genes amp PD

Dr W Langston of Parkinsonrsquos Dr W Langston of Parkinsonrsquos Institute ldquoAccelerating Research on Institute ldquoAccelerating Research on Genes and Environment in Genes and Environment in Parkinsonrsquos Diseaserdquo (2005)Parkinsonrsquos Diseaserdquo (2005)

Two PD studies underway one in Two PD studies underway one in pesticide applicators other in two pesticide applicators other in two CA counties with known heavy CA counties with known heavy exposureexposure

Other Health Impacts of Other Health Impacts of PesticidesPesticides

ArrhythmiasArrhythmiasAsthmaAsthmaLymphomas Brain tumorsLymphomas Brain tumorsAbnormal sperm countsAbnormal sperm countsBirth defects amp developmental delaysBirth defects amp developmental delaysHyperactivity amp behavioral problemsHyperactivity amp behavioral problemsDecreased endurance amp coordinationDecreased endurance amp coordinationNeurocognitive problemsNeurocognitive problemsPeripheral neuropathiesPeripheral neuropathies

Pesticides a Persistent Pesticides a Persistent ProblemProblem

Major classesMajor classes insecticides fungicides insecticides fungicides herbicides rodenticidesherbicides rodenticides

1997 Market1997 Market US $119 billion World $37 US $119 billion World $37 billionbillion

HistoryHistory synthetic-new to humans amp synthetic-new to humans amp environment since 1940s gt800 licensed environment since 1940s gt800 licensed ldquoactiverdquo ingredientsldquoactiverdquo ingredients

Manufacturers Manufacturers Bayer Aventis other drug Bayer Aventis other drug coco

Inherent toxicityInherent toxicity 140 pesticides considered 140 pesticides considered neurotoxic 37 are used on food ampor feedneurotoxic 37 are used on food ampor feed

Insecticide Sites of Insecticide Sites of ActionAction

Enzymes

Axonal Membranes

Ions (Na+ K+ Ca++ Cl-)

Enzymes

Neurotransmitters

Organochlorines

Pyrethroids

Casarett and Doullrsquos Toxicology The Basic Science of Poisons 5th Edition Ed Klaassen CD

McGraw-Hill New York 1996 P 649

Organophosphorus and

Carbamate Esters

Organophosphate PesticidesOrganophosphate PesticidesOccurrence and distribution in surface amp

ground water of the United States 1992-97

httpgawaterusgsgovpublicationsabstractsofr00-187html

Background Pesticide Background Pesticide Exposures WidespreadExposures Widespread

Reported useReported use 98 of families 80 during 98 of families 80 during pregnancypregnancy

In HumansIn Humans detectable chlorpyrifos detectable chlorpyrifos metabolites in 92 of childrenrsquos 82 of metabolites in 92 of childrenrsquos 82 of adultsrsquo urine samplesadultsrsquo urine samples

In FoodIn Food residues of at least one pesticide on residues of at least one pesticide on 72 fruits amp vegetables72 fruits amp vegetables

In HomesIn Homes 3 to 9 pesticide residues found3 to 9 pesticide residues found

In AirIn Air indoor levels 10-100X higher than indoor levels 10-100X higher than outdooroutdoor

In WaterIn Water gt90 stream samples 50 of gt90 stream samples 50 of wellswells

Sources of PesticidesSources of Pesticides

Household uses lawn amp garden Household uses lawn amp garden sprays exterminators flea collarssprays exterminators flea collars

Household dust (tracking in on shoes)Household dust (tracking in on shoes)

Public schools hospitals parks Public schools hospitals parks childcare facilitieschildcare facilities

Agricultural uses amp workersrsquo clothesAgricultural uses amp workersrsquo clothes

Non-organic foodsNon-organic foods

Breast milkBreast milk

Strategies to Reduces Strategies to Reduces Exposure to Home amp Garden Exposure to Home amp Garden

Pesticides in OregonPesticides in OregonPolicy SolutionsPolicy Solutions OR pesticide use reporting system OR pesticide use reporting system

(1999) finally funded 2005(1999) finally funded 2005 Educate homeowners re nontoxic Educate homeowners re nontoxic

options options Enc pet owners to use flea combs and Enc pet owners to use flea combs and

vacuuming to control fleasvacuuming to control fleas Enc public places to use Integrated Enc public places to use Integrated

Pest Management (IPM) ie Pesticide Pest Management (IPM) ie Pesticide Free ParksFree Parks

What YOU Can Do about What YOU Can Do about PesticidesPesticides

Advise PatientsAdvise Patients Regularly dustRegularly dust Use Integrated Pest Management Use Integrated Pest Management Cleanremove shoes outsideCleanremove shoes outside Keep contaminated clothes separateKeep contaminated clothes separate Buy sustainably grown foodBuy sustainably grown food Store food in secure nontoxic Store food in secure nontoxic

containerscontainers

Mercury amp Women of Mercury amp Women of Childbearing AgeChildbearing Age

A 32 yo G0P0 woman of A 32 yo G0P0 woman of childbearing age (WCBA) childbearing age (WCBA) presents for annual PE presents for annual PE

PMH negativePMH negative

Social hx husband is Social hx husband is recreational fisherman recreational fisherman

Contemplating pregnancy Contemplating pregnancy

Should she avoid fish Should she avoid fish because of mercury risks because of mercury risks to the fetusto the fetus

Mercury amp WCBAMercury amp WCBA

gt10gt10 of WCBA exceed safe limit of of WCBA exceed safe limit of 1ugkgday1ugkgday

5050 of women of women who eat fishwho eat fish exceed exceed limitlimit

5757 of WCBA have Hg levels of WCBA have Hg levels concerning for adverse effects concerning for adverse effects (CDC (CDC Natrsquol Report 0705Natrsquol Report 0705))

Higher risk Higher risk 300 000 childrenyear 300 000 childrenyear subsistence fishers immigrants subsistence fishers immigrants Native AmericansNative Americans

Mercury amp WCBAMercury amp WCBA

Hg enters tissues variable excretionHg enters tissues variable excretion Breast Milk PCBs DDT amp other Breast Milk PCBs DDT amp other

pesticides dioxins dibenzofurans pesticides dioxins dibenzofurans toxic flame retardants amp heavy toxic flame retardants amp heavy metals (Pb amp Hg) metals (Pb amp Hg)

No bio-accumulation in milk but No bio-accumulation in milk but levels in fish-eaters may exceed levels in fish-eaters may exceed unexposed women by 100x unexposed women by 100x

Scientific evidence indicates Scientific evidence indicates advantages of breast-feeding advantages of breast-feeding outweigh riskshellipoutweigh riskshellip

Neuro Effects of MercuryNeuro Effects of Mercury

Cerebral palsyCerebral palsy MRDDMRDD disequilibrium ataxiadisequilibrium ataxia hearing lossdeafnesshearing lossdeafness visual visual

impairmentblindnessimpairmentblindness peripheral neuropathyperipheral neuropathy parasthesiasparasthesias tremors seizures tremors seizures abnl reflexes amp muscle toneabnl reflexes amp muscle tone Psychiatric disturbances Psychiatric disturbances

Mercury a Persistent Mercury a Persistent ProblemProblem

PoisoningsPoisonings Minamata 1950s amp Iraq Minamata 1950s amp Iraq 19711971

Nationally ~Nationally ~160 tons of Hg annually160 tons of Hg annually In OregonIn Oregon ~ ~4500 lbs annually4500 lbs annually Lack of regulationLack of regulation In OR 10 facilities In OR 10 facilities

report Hg release-none has a permit or is report Hg release-none has a permit or is required to monitor emissions by staterequired to monitor emissions by state

Fish AdvisoriesFish Advisories in 2004 45 states had in 2004 45 states had gt2000 warnings Oregon lists advisories gt2000 warnings Oregon lists advisories for 12 water bodies inc Willamette for 12 water bodies inc Willamette

Atmospheric HgAtmospheric Hg

The Mercury CycleThe Mercury Cycle

MercuryMercuryDeclining Threshold of Declining Threshold of

HarmHarm

2000199019801970001

01

1

10

100

YEAR

Level associated with harmful effectRegulatory standard (maximum safe exposure or high end exposure from allowed fish contamination)

FDA WHO

EPA

ATSDR

DA

ILY

IN

TA

KE

(mic

rogr

ams

kg

day

Hg)

Sources of MercurySources of MercuryIndustrial emissions Industrial emissions

coal fired plantscoal fired plantsMunicipal amp medical Municipal amp medical

waste incineratorswaste incineratorsAbandoned Hg amp gold Abandoned Hg amp gold

minesminesNatural off-gassing Natural off-gassing Dental amalgamsDental amalgamsBioaccumulation in Bioaccumulation in

foods esp fishfoods esp fishOld thermometers BP Old thermometers BP

cuffs amp auto cuffs amp auto switchesswitches

Strategies to Reduce Strategies to Reduce Mercury Pollution in Mercury Pollution in

OregonOregonPolicy SolutionsPolicy Solutions Mercury Solutions Act of 2001Mercury Solutions Act of 2001 Ensure safe collection amp recyclingEnsure safe collection amp recycling Clean up abandoned mines and Clean up abandoned mines and

SuperfundsSuperfunds Reduce Hg emissions from health Reduce Hg emissions from health

care facilitiescare facilities Inc Hg in applicable DEQ air amp Inc Hg in applicable DEQ air amp

water permitswater permits Coal burning power plant Boardman Coal burning power plant Boardman

OR OR Implement OR Executive OrderImplement OR Executive Order

What YOU Can Do about What YOU Can Do about MercuryMercury

Advise PatientsAdvise Patients Provide Provide An Expectant Motherrsquos Guide to An Expectant Motherrsquos Guide to

Eating Fish in Oregon (DHS) Eating Fish in Oregon (DHS) in waiting in waiting roomsrooms

Rec WCBA and children avoid fish wHgRec WCBA and children avoid fish wHg Enc WCBA to consume low-fat dietEnc WCBA to consume low-fat diet Recycle old Hg thermometers Recycle old Hg thermometers

thermostats amp fluorescent light tubesthermostats amp fluorescent light tubes Have car checked for Hg switches at Have car checked for Hg switches at

participating auto shop (free participating auto shop (free replacement)replacement)

Use digital thermometers amp thermostatsUse digital thermometers amp thermostats

SummarySummary Chronic Diseases are prevalent Toxic Chronic Diseases are prevalent Toxic

exposures are possible exposures are possible preventablepreventable contributorscontributors

Pesticides amp risk of Parkinsonrsquos and Mercury Pesticides amp risk of Parkinsonrsquos and Mercury risks to WCBA are more understood than most risks to WCBA are more understood than most toxins and other chronic diseasestoxins and other chronic diseases

Apparent toxicity at high doses should be a Apparent toxicity at high doses should be a red flag for possible harm from low dose red flag for possible harm from low dose chronic exposureschronic exposures

Since ldquoproofrdquo of harm materializes slowly Since ldquoproofrdquo of harm materializes slowly generations are at risk and may be harmed generations are at risk and may be harmed before adequate regulatory response occursbefore adequate regulatory response occurs

Kaiser amp HCWHh2eKaiser amp HCWHh2e

Clean Diesel Hospital Zones ProjectClean Diesel Hospital Zones Project Healthy Food in Healthcare InitiativeHealthy Food in Healthcare Initiative Green Building PVC and DEHP free Green Building PVC and DEHP free

NICU NICU Environmentally preferable purchasing Environmentally preferable purchasing

policypolicy Making Medicine Mercury Free Award Making Medicine Mercury Free Award h2e Environmental Leadership Award h2e Environmental Leadership Award

20022002

What Can You DoWhat Can You Do

Be aware of environmental toxins amp Be aware of environmental toxins amp their possible links to chronic diseasestheir possible links to chronic diseases

Provide advice amp education on Provide advice amp education on prevention andor minimizing prevention andor minimizing exposures or refer appropriately exposures or refer appropriately

Incorporate environmental questions Incorporate environmental questions into clinical historyinto clinical history

Advocate Advocate wwwenvirohealthactionorgwwwenvirohealthactionorg

Local AdvocacyLocal Advocacy Oregon Environmental CouncilOregon Environmental Council wwwoeconlineorgwwwoeconlineorg Oregon Collaborative on Health amp Oregon Collaborative on Health amp

EnvironmentEnvironment Healthy Environment ForumsHealthy Environment Forums Oregon Center for Environmental HealthOregon Center for Environmental Health wwworegon-healthorgwwworegon-healthorg Healthcare without HarmHealthcare without Harm Hospitals for Healthy Environment (h2e)Hospitals for Healthy Environment (h2e) Oregon PSROregon PSR wwworegonpsrorgwwworegonpsrorg Environmental Health-In Harmrsquos Way Environmental Health-In Harmrsquos Way

State of Knowledge Our State of Knowledge Our Chemical EnvironmentChemical Environment

gt80000 chemicals in gt80000 chemicals in Federal inventoryFederal inventory

2000 to 3000 NEW 2000 to 3000 NEW chemicals per yearchemicals per year

gt4 billion lbs released gt4 billion lbs released into environment yearly into environment yearly 72 million lbs of 72 million lbs of recognized carcinogens recognized carcinogens

Basic Screening Basic Screening Information Data Set Information Data Set (SIDS) avg $205000 per (SIDS) avg $205000 per chemicalchemical

Hazard Data - Chemicals Hazard Data - Chemicals Produced Produced

gt 1 Million PoundsYear gt 1 Million PoundsYear

0 10 20 30 40 50 60 70 80 90 100

Percentage Tested

Acute Toxicity

Environmental Fate

Ecotoxicity

Mutagenicity

Chronic Toxicity

ReproductiveToxicity

Full Set of BasicToxicity Tests

Medical WasteMedical Waste

6000 US hospitals~2 million 6000 US hospitals~2 million tons waste per year tons waste per year

Clinics and doctorsrsquo offices add 700000 Clinics and doctorsrsquo offices add 700000 tonstons

EPA regulations weak-HCWHh2eEPA regulations weak-HCWHh2e 850000 tons incinerated850000 tons incinerated

Pollutants inc dioxin Hg cadmium Pollutants inc dioxin Hg cadmium and Pband Pb

Segregation amp alternatives to Segregation amp alternatives to incineration incineration would cost 93 would cost 93 centspatientdaycentspatientday

Our Chemical EnvironmentOur Chemical Environment

1305 Superfund sites1305 Superfund sites 25002500 are are eligible eligible gt80kgt80k hazardous sites hazardous sites knownknown

~11 million people live within 1 mile~11 million people live within 1 mile ~25 live within 4 miles~25 live within 4 miles OR ranks 24OR ranks 24-12 Superfund sites-12 Superfund sites 3 in PDX3 in PDX Harbor Oil Portland Harbor Oil Portland

Harbor Harbor McCormick amp Baxter McCormick amp Baxter Creosoting Co Creosoting Co

Multnomah amp Washington CoMultnomah amp Washington CoShared Pollutants 2002Shared Pollutants 2002

Links to Disease Links to Disease

Methanol (gt240k lbs)Methanol (gt240k lbs)

StrongStrong ATN amp vision problems ATN amp vision problems

GoodGood Pancreatitis amp Pancreatitis amp Parkinsonrsquosmovement disorders Parkinsonrsquosmovement disorders

Ammonia (gt100k lbs)Ammonia (gt100k lbs)

StrongStrong Asthma acutechronic bronchitis Asthma acutechronic bronchitis olfactory disorders amp rhinitis olfactory disorders amp rhinitis

GoodGood Pulmonary edema Pulmonary edema

Links to Disease contLinks to Disease cont

Xylene (gt95k lbs) amp Toluene (gt83k lbs)Xylene (gt95k lbs) amp Toluene (gt83k lbs) GoodGood Scleroderma arrhythmias menstrual Scleroderma arrhythmias menstrual

do cognitive impairment hearing loss amp do cognitive impairment hearing loss amp fetal death (miscarriagestillbirth)fetal death (miscarriagestillbirth)

Glycol Ethers (gt20k lbs)Glycol Ethers (gt20k lbs) StrongStrong Reduced male fertility abnormal Reduced male fertility abnormal

sperm (morphology motility amp count) amp fetal sperm (morphology motility amp count) amp fetal death (miscarriagestillbirth) death (miscarriagestillbirth)

GoodGood ATN reduced female fertility general ATN reduced female fertility general congenital and craniofacial malformationscongenital and craniofacial malformations

National Report on Human National Report on Human Exposure to Environmental Exposure to Environmental

Chemicals Chemicals (CDC 705)(CDC 705)

Random selection from NHANES Random selection from NHANES surveysurvey

148 chemicals from 2001-2002 inc 148 chemicals from 2001-2002 inc data on 116 chemicals from 1999-data on 116 chemicals from 1999-20002000

Criteria for chemical inclusion Criteria for chemical inclusion wide exposure wide exposure serious health effects serious health effects adequate blood amp urine samples adequate blood amp urine samples efficacy of attempts to reduce efficacy of attempts to reduce

exposure exposure availability of reliable bio-monitoring availability of reliable bio-monitoring

methodmethod

CDC Report GoalsCDC Report Goals

Which chemicals are present amp Which chemicals are present amp concentrations concentrations

How many people have levels above How many people have levels above known toxicity thresholdsknown toxicity thresholds

Establish reference ranges Establish reference ranges Determine if levels are higher in at Determine if levels are higher in at

risk populations risk populations Track trends over time Track trends over time Set priorities for researchSet priorities for research

CDC Report HighlightsCDC Report Highlights

First time data for 38148 chemicalsFirst time data for 38148 chemicals BLL declining 44 of children early BLL declining 44 of children early

1990s 16 of children from 1999-1990s 16 of children from 1999-20022002

Hg in women of childbearing age Hg in women of childbearing age 57 have concerning levels57 have concerning levels

Pyrethroid insecticides (common Pyrethroid insecticides (common home use) 76 of populationhome use) 76 of population

Highlights contHighlights cont

Levels of 3 toxic pesticides- Levels of 3 toxic pesticides- Aldrin Dieldrin amp Endrin-very low Aldrin Dieldrin amp Endrin-very low

29 Dioxin-like compounds levels are 29 Dioxin-like compounds levels are declining declining

Cadmium 5 population gt20yrs age Cadmium 5 population gt20yrs age levels near toxic limit (kidney dz low levels near toxic limit (kidney dz low BMD)BMD)

Phthalates widespread higher in Phthalates widespread higher in women amp childrenwomen amp children

Limitations of Current DataLimitations of Current Data

Exposure to chemical mixtures Exposure to chemical mixtures common-research more complexcommon-research more complex

Data available for only minority Data available for only minority single agentssingle agents

Epidemiological amp animal studies Epidemiological amp animal studies often only data availableoften only data available

Result links btw Chronic Diseases amp Result links btw Chronic Diseases amp low dose chronic complex exposures low dose chronic complex exposures hard to ldquoproverdquohard to ldquoproverdquo

PROVEN HARM

PARTIALLY PROVEN

NOT YET RECOGNIZED

FOREVER UNRECOGNIZED

THE TOXIC ICEBERG________________________________________

Oregoniansrsquo HealthOregoniansrsquo Health12 CHEMICALS OF KEY CONCERN12 CHEMICALS OF KEY CONCERN 1048698 1048698 acroleinacrolein 1048698 1048698 benzenebenzene 1048698 1048698 benzo(a)pyrenebenzo(a)pyrene 1048698 1048698 bisphenol-Abisphenol-A 1048698 1048698 brominated flame retardants (BFRs)brominated flame retardants (BFRs) 1048698 1048698 dieseldiesel 1048698 1048698 dioxindioxin 1048698 1048698 formaldehydeformaldehyde 1048698 1048698 leadlead 1048698 1048698 mercurymercury home amp garden pesticideshome amp garden pesticides 1048698 1048698 phthalatesphthalates

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

A 52 yr-old pt co increasing tremor A 52 yr-old pt co increasing tremor On PE the tremor is pill-rolling and On PE the tremor is pill-rolling and resolves with intention +Romberg resolves with intention +Romberg sign unstable tandem gaitsign unstable tandem gait

You make a preliminary diagnosis of You make a preliminary diagnosis of early Parkinsonrsquos diseaseearly Parkinsonrsquos disease

Wife mentions reading about Wife mentions reading about environmental links to PD pt is a environmental links to PD pt is a farmer and has used pesticides for farmer and has used pesticides for years Could this be related to his years Could this be related to his diseasedisease

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

Paraquat rotenone organophosphates Paraquat rotenone organophosphates dieldrin and fungicides maneb amp dieldrin and fungicides maneb amp mancozeb implicatedmancozeb implicated

MPTP a designer heroin-like drug MPTP a designer heroin-like drug causes Parkinsonian syndrome in causes Parkinsonian syndrome in addictsaddicts

Higher incidence in industrialized Higher incidence in industrialized countries greatest risk in rural countries greatest risk in rural areasfarms prolonged pesticide useareasfarms prolonged pesticide use

Case control studies herbicide or Case control studies herbicide or insecticide exposure 3-4x likelyinsecticide exposure 3-4x likely

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

2005 Brown T et al Meta-analysis 2005 Brown T et al Meta-analysis of epidemi-ologic amp toxicologic of epidemi-ologic amp toxicologic studies since 1983 studies since 1983

Verified most of these links noting Verified most of these links noting limitations in study designs limitations in study designs

Conclusion ldquogeneric association btw Conclusion ldquogeneric association btw pesticide exposure amp PD exists but pesticide exposure amp PD exists but is insufficient tohellipconcludehellipa causal is insufficient tohellipconcludehellipa causal relationshiprdquo relationshiprdquo

Pesticides Genes amp PDPesticides Genes amp PD

Dr W Langston of Parkinsonrsquos Dr W Langston of Parkinsonrsquos Institute ldquoAccelerating Research on Institute ldquoAccelerating Research on Genes and Environment in Genes and Environment in Parkinsonrsquos Diseaserdquo (2005)Parkinsonrsquos Diseaserdquo (2005)

Two PD studies underway one in Two PD studies underway one in pesticide applicators other in two pesticide applicators other in two CA counties with known heavy CA counties with known heavy exposureexposure

Other Health Impacts of Other Health Impacts of PesticidesPesticides

ArrhythmiasArrhythmiasAsthmaAsthmaLymphomas Brain tumorsLymphomas Brain tumorsAbnormal sperm countsAbnormal sperm countsBirth defects amp developmental delaysBirth defects amp developmental delaysHyperactivity amp behavioral problemsHyperactivity amp behavioral problemsDecreased endurance amp coordinationDecreased endurance amp coordinationNeurocognitive problemsNeurocognitive problemsPeripheral neuropathiesPeripheral neuropathies

Pesticides a Persistent Pesticides a Persistent ProblemProblem

Major classesMajor classes insecticides fungicides insecticides fungicides herbicides rodenticidesherbicides rodenticides

1997 Market1997 Market US $119 billion World $37 US $119 billion World $37 billionbillion

HistoryHistory synthetic-new to humans amp synthetic-new to humans amp environment since 1940s gt800 licensed environment since 1940s gt800 licensed ldquoactiverdquo ingredientsldquoactiverdquo ingredients

Manufacturers Manufacturers Bayer Aventis other drug Bayer Aventis other drug coco

Inherent toxicityInherent toxicity 140 pesticides considered 140 pesticides considered neurotoxic 37 are used on food ampor feedneurotoxic 37 are used on food ampor feed

Insecticide Sites of Insecticide Sites of ActionAction

Enzymes

Axonal Membranes

Ions (Na+ K+ Ca++ Cl-)

Enzymes

Neurotransmitters

Organochlorines

Pyrethroids

Casarett and Doullrsquos Toxicology The Basic Science of Poisons 5th Edition Ed Klaassen CD

McGraw-Hill New York 1996 P 649

Organophosphorus and

Carbamate Esters

Organophosphate PesticidesOrganophosphate PesticidesOccurrence and distribution in surface amp

ground water of the United States 1992-97

httpgawaterusgsgovpublicationsabstractsofr00-187html

Background Pesticide Background Pesticide Exposures WidespreadExposures Widespread

Reported useReported use 98 of families 80 during 98 of families 80 during pregnancypregnancy

In HumansIn Humans detectable chlorpyrifos detectable chlorpyrifos metabolites in 92 of childrenrsquos 82 of metabolites in 92 of childrenrsquos 82 of adultsrsquo urine samplesadultsrsquo urine samples

In FoodIn Food residues of at least one pesticide on residues of at least one pesticide on 72 fruits amp vegetables72 fruits amp vegetables

In HomesIn Homes 3 to 9 pesticide residues found3 to 9 pesticide residues found

In AirIn Air indoor levels 10-100X higher than indoor levels 10-100X higher than outdooroutdoor

In WaterIn Water gt90 stream samples 50 of gt90 stream samples 50 of wellswells

Sources of PesticidesSources of Pesticides

Household uses lawn amp garden Household uses lawn amp garden sprays exterminators flea collarssprays exterminators flea collars

Household dust (tracking in on shoes)Household dust (tracking in on shoes)

Public schools hospitals parks Public schools hospitals parks childcare facilitieschildcare facilities

Agricultural uses amp workersrsquo clothesAgricultural uses amp workersrsquo clothes

Non-organic foodsNon-organic foods

Breast milkBreast milk

Strategies to Reduces Strategies to Reduces Exposure to Home amp Garden Exposure to Home amp Garden

Pesticides in OregonPesticides in OregonPolicy SolutionsPolicy Solutions OR pesticide use reporting system OR pesticide use reporting system

(1999) finally funded 2005(1999) finally funded 2005 Educate homeowners re nontoxic Educate homeowners re nontoxic

options options Enc pet owners to use flea combs and Enc pet owners to use flea combs and

vacuuming to control fleasvacuuming to control fleas Enc public places to use Integrated Enc public places to use Integrated

Pest Management (IPM) ie Pesticide Pest Management (IPM) ie Pesticide Free ParksFree Parks

What YOU Can Do about What YOU Can Do about PesticidesPesticides

Advise PatientsAdvise Patients Regularly dustRegularly dust Use Integrated Pest Management Use Integrated Pest Management Cleanremove shoes outsideCleanremove shoes outside Keep contaminated clothes separateKeep contaminated clothes separate Buy sustainably grown foodBuy sustainably grown food Store food in secure nontoxic Store food in secure nontoxic

containerscontainers

Mercury amp Women of Mercury amp Women of Childbearing AgeChildbearing Age

A 32 yo G0P0 woman of A 32 yo G0P0 woman of childbearing age (WCBA) childbearing age (WCBA) presents for annual PE presents for annual PE

PMH negativePMH negative

Social hx husband is Social hx husband is recreational fisherman recreational fisherman

Contemplating pregnancy Contemplating pregnancy

Should she avoid fish Should she avoid fish because of mercury risks because of mercury risks to the fetusto the fetus

Mercury amp WCBAMercury amp WCBA

gt10gt10 of WCBA exceed safe limit of of WCBA exceed safe limit of 1ugkgday1ugkgday

5050 of women of women who eat fishwho eat fish exceed exceed limitlimit

5757 of WCBA have Hg levels of WCBA have Hg levels concerning for adverse effects concerning for adverse effects (CDC (CDC Natrsquol Report 0705Natrsquol Report 0705))

Higher risk Higher risk 300 000 childrenyear 300 000 childrenyear subsistence fishers immigrants subsistence fishers immigrants Native AmericansNative Americans

Mercury amp WCBAMercury amp WCBA

Hg enters tissues variable excretionHg enters tissues variable excretion Breast Milk PCBs DDT amp other Breast Milk PCBs DDT amp other

pesticides dioxins dibenzofurans pesticides dioxins dibenzofurans toxic flame retardants amp heavy toxic flame retardants amp heavy metals (Pb amp Hg) metals (Pb amp Hg)

No bio-accumulation in milk but No bio-accumulation in milk but levels in fish-eaters may exceed levels in fish-eaters may exceed unexposed women by 100x unexposed women by 100x

Scientific evidence indicates Scientific evidence indicates advantages of breast-feeding advantages of breast-feeding outweigh riskshellipoutweigh riskshellip

Neuro Effects of MercuryNeuro Effects of Mercury

Cerebral palsyCerebral palsy MRDDMRDD disequilibrium ataxiadisequilibrium ataxia hearing lossdeafnesshearing lossdeafness visual visual

impairmentblindnessimpairmentblindness peripheral neuropathyperipheral neuropathy parasthesiasparasthesias tremors seizures tremors seizures abnl reflexes amp muscle toneabnl reflexes amp muscle tone Psychiatric disturbances Psychiatric disturbances

Mercury a Persistent Mercury a Persistent ProblemProblem

PoisoningsPoisonings Minamata 1950s amp Iraq Minamata 1950s amp Iraq 19711971

Nationally ~Nationally ~160 tons of Hg annually160 tons of Hg annually In OregonIn Oregon ~ ~4500 lbs annually4500 lbs annually Lack of regulationLack of regulation In OR 10 facilities In OR 10 facilities

report Hg release-none has a permit or is report Hg release-none has a permit or is required to monitor emissions by staterequired to monitor emissions by state

Fish AdvisoriesFish Advisories in 2004 45 states had in 2004 45 states had gt2000 warnings Oregon lists advisories gt2000 warnings Oregon lists advisories for 12 water bodies inc Willamette for 12 water bodies inc Willamette

Atmospheric HgAtmospheric Hg

The Mercury CycleThe Mercury Cycle

MercuryMercuryDeclining Threshold of Declining Threshold of

HarmHarm

2000199019801970001

01

1

10

100

YEAR

Level associated with harmful effectRegulatory standard (maximum safe exposure or high end exposure from allowed fish contamination)

FDA WHO

EPA

ATSDR

DA

ILY

IN

TA

KE

(mic

rogr

ams

kg

day

Hg)

Sources of MercurySources of MercuryIndustrial emissions Industrial emissions

coal fired plantscoal fired plantsMunicipal amp medical Municipal amp medical

waste incineratorswaste incineratorsAbandoned Hg amp gold Abandoned Hg amp gold

minesminesNatural off-gassing Natural off-gassing Dental amalgamsDental amalgamsBioaccumulation in Bioaccumulation in

foods esp fishfoods esp fishOld thermometers BP Old thermometers BP

cuffs amp auto cuffs amp auto switchesswitches

Strategies to Reduce Strategies to Reduce Mercury Pollution in Mercury Pollution in

OregonOregonPolicy SolutionsPolicy Solutions Mercury Solutions Act of 2001Mercury Solutions Act of 2001 Ensure safe collection amp recyclingEnsure safe collection amp recycling Clean up abandoned mines and Clean up abandoned mines and

SuperfundsSuperfunds Reduce Hg emissions from health Reduce Hg emissions from health

care facilitiescare facilities Inc Hg in applicable DEQ air amp Inc Hg in applicable DEQ air amp

water permitswater permits Coal burning power plant Boardman Coal burning power plant Boardman

OR OR Implement OR Executive OrderImplement OR Executive Order

What YOU Can Do about What YOU Can Do about MercuryMercury

Advise PatientsAdvise Patients Provide Provide An Expectant Motherrsquos Guide to An Expectant Motherrsquos Guide to

Eating Fish in Oregon (DHS) Eating Fish in Oregon (DHS) in waiting in waiting roomsrooms

Rec WCBA and children avoid fish wHgRec WCBA and children avoid fish wHg Enc WCBA to consume low-fat dietEnc WCBA to consume low-fat diet Recycle old Hg thermometers Recycle old Hg thermometers

thermostats amp fluorescent light tubesthermostats amp fluorescent light tubes Have car checked for Hg switches at Have car checked for Hg switches at

participating auto shop (free participating auto shop (free replacement)replacement)

Use digital thermometers amp thermostatsUse digital thermometers amp thermostats

SummarySummary Chronic Diseases are prevalent Toxic Chronic Diseases are prevalent Toxic

exposures are possible exposures are possible preventablepreventable contributorscontributors

Pesticides amp risk of Parkinsonrsquos and Mercury Pesticides amp risk of Parkinsonrsquos and Mercury risks to WCBA are more understood than most risks to WCBA are more understood than most toxins and other chronic diseasestoxins and other chronic diseases

Apparent toxicity at high doses should be a Apparent toxicity at high doses should be a red flag for possible harm from low dose red flag for possible harm from low dose chronic exposureschronic exposures

Since ldquoproofrdquo of harm materializes slowly Since ldquoproofrdquo of harm materializes slowly generations are at risk and may be harmed generations are at risk and may be harmed before adequate regulatory response occursbefore adequate regulatory response occurs

Kaiser amp HCWHh2eKaiser amp HCWHh2e

Clean Diesel Hospital Zones ProjectClean Diesel Hospital Zones Project Healthy Food in Healthcare InitiativeHealthy Food in Healthcare Initiative Green Building PVC and DEHP free Green Building PVC and DEHP free

NICU NICU Environmentally preferable purchasing Environmentally preferable purchasing

policypolicy Making Medicine Mercury Free Award Making Medicine Mercury Free Award h2e Environmental Leadership Award h2e Environmental Leadership Award

20022002

What Can You DoWhat Can You Do

Be aware of environmental toxins amp Be aware of environmental toxins amp their possible links to chronic diseasestheir possible links to chronic diseases

Provide advice amp education on Provide advice amp education on prevention andor minimizing prevention andor minimizing exposures or refer appropriately exposures or refer appropriately

Incorporate environmental questions Incorporate environmental questions into clinical historyinto clinical history

Advocate Advocate wwwenvirohealthactionorgwwwenvirohealthactionorg

Local AdvocacyLocal Advocacy Oregon Environmental CouncilOregon Environmental Council wwwoeconlineorgwwwoeconlineorg Oregon Collaborative on Health amp Oregon Collaborative on Health amp

EnvironmentEnvironment Healthy Environment ForumsHealthy Environment Forums Oregon Center for Environmental HealthOregon Center for Environmental Health wwworegon-healthorgwwworegon-healthorg Healthcare without HarmHealthcare without Harm Hospitals for Healthy Environment (h2e)Hospitals for Healthy Environment (h2e) Oregon PSROregon PSR wwworegonpsrorgwwworegonpsrorg Environmental Health-In Harmrsquos Way Environmental Health-In Harmrsquos Way

Hazard Data - Chemicals Hazard Data - Chemicals Produced Produced

gt 1 Million PoundsYear gt 1 Million PoundsYear

0 10 20 30 40 50 60 70 80 90 100

Percentage Tested

Acute Toxicity

Environmental Fate

Ecotoxicity

Mutagenicity

Chronic Toxicity

ReproductiveToxicity

Full Set of BasicToxicity Tests

Medical WasteMedical Waste

6000 US hospitals~2 million 6000 US hospitals~2 million tons waste per year tons waste per year

Clinics and doctorsrsquo offices add 700000 Clinics and doctorsrsquo offices add 700000 tonstons

EPA regulations weak-HCWHh2eEPA regulations weak-HCWHh2e 850000 tons incinerated850000 tons incinerated

Pollutants inc dioxin Hg cadmium Pollutants inc dioxin Hg cadmium and Pband Pb

Segregation amp alternatives to Segregation amp alternatives to incineration incineration would cost 93 would cost 93 centspatientdaycentspatientday

Our Chemical EnvironmentOur Chemical Environment

1305 Superfund sites1305 Superfund sites 25002500 are are eligible eligible gt80kgt80k hazardous sites hazardous sites knownknown

~11 million people live within 1 mile~11 million people live within 1 mile ~25 live within 4 miles~25 live within 4 miles OR ranks 24OR ranks 24-12 Superfund sites-12 Superfund sites 3 in PDX3 in PDX Harbor Oil Portland Harbor Oil Portland

Harbor Harbor McCormick amp Baxter McCormick amp Baxter Creosoting Co Creosoting Co

Multnomah amp Washington CoMultnomah amp Washington CoShared Pollutants 2002Shared Pollutants 2002

Links to Disease Links to Disease

Methanol (gt240k lbs)Methanol (gt240k lbs)

StrongStrong ATN amp vision problems ATN amp vision problems

GoodGood Pancreatitis amp Pancreatitis amp Parkinsonrsquosmovement disorders Parkinsonrsquosmovement disorders

Ammonia (gt100k lbs)Ammonia (gt100k lbs)

StrongStrong Asthma acutechronic bronchitis Asthma acutechronic bronchitis olfactory disorders amp rhinitis olfactory disorders amp rhinitis

GoodGood Pulmonary edema Pulmonary edema

Links to Disease contLinks to Disease cont

Xylene (gt95k lbs) amp Toluene (gt83k lbs)Xylene (gt95k lbs) amp Toluene (gt83k lbs) GoodGood Scleroderma arrhythmias menstrual Scleroderma arrhythmias menstrual

do cognitive impairment hearing loss amp do cognitive impairment hearing loss amp fetal death (miscarriagestillbirth)fetal death (miscarriagestillbirth)

Glycol Ethers (gt20k lbs)Glycol Ethers (gt20k lbs) StrongStrong Reduced male fertility abnormal Reduced male fertility abnormal

sperm (morphology motility amp count) amp fetal sperm (morphology motility amp count) amp fetal death (miscarriagestillbirth) death (miscarriagestillbirth)

GoodGood ATN reduced female fertility general ATN reduced female fertility general congenital and craniofacial malformationscongenital and craniofacial malformations

National Report on Human National Report on Human Exposure to Environmental Exposure to Environmental

Chemicals Chemicals (CDC 705)(CDC 705)

Random selection from NHANES Random selection from NHANES surveysurvey

148 chemicals from 2001-2002 inc 148 chemicals from 2001-2002 inc data on 116 chemicals from 1999-data on 116 chemicals from 1999-20002000

Criteria for chemical inclusion Criteria for chemical inclusion wide exposure wide exposure serious health effects serious health effects adequate blood amp urine samples adequate blood amp urine samples efficacy of attempts to reduce efficacy of attempts to reduce

exposure exposure availability of reliable bio-monitoring availability of reliable bio-monitoring

methodmethod

CDC Report GoalsCDC Report Goals

Which chemicals are present amp Which chemicals are present amp concentrations concentrations

How many people have levels above How many people have levels above known toxicity thresholdsknown toxicity thresholds

Establish reference ranges Establish reference ranges Determine if levels are higher in at Determine if levels are higher in at

risk populations risk populations Track trends over time Track trends over time Set priorities for researchSet priorities for research

CDC Report HighlightsCDC Report Highlights

First time data for 38148 chemicalsFirst time data for 38148 chemicals BLL declining 44 of children early BLL declining 44 of children early

1990s 16 of children from 1999-1990s 16 of children from 1999-20022002

Hg in women of childbearing age Hg in women of childbearing age 57 have concerning levels57 have concerning levels

Pyrethroid insecticides (common Pyrethroid insecticides (common home use) 76 of populationhome use) 76 of population

Highlights contHighlights cont

Levels of 3 toxic pesticides- Levels of 3 toxic pesticides- Aldrin Dieldrin amp Endrin-very low Aldrin Dieldrin amp Endrin-very low

29 Dioxin-like compounds levels are 29 Dioxin-like compounds levels are declining declining

Cadmium 5 population gt20yrs age Cadmium 5 population gt20yrs age levels near toxic limit (kidney dz low levels near toxic limit (kidney dz low BMD)BMD)

Phthalates widespread higher in Phthalates widespread higher in women amp childrenwomen amp children

Limitations of Current DataLimitations of Current Data

Exposure to chemical mixtures Exposure to chemical mixtures common-research more complexcommon-research more complex

Data available for only minority Data available for only minority single agentssingle agents

Epidemiological amp animal studies Epidemiological amp animal studies often only data availableoften only data available

Result links btw Chronic Diseases amp Result links btw Chronic Diseases amp low dose chronic complex exposures low dose chronic complex exposures hard to ldquoproverdquohard to ldquoproverdquo

PROVEN HARM

PARTIALLY PROVEN

NOT YET RECOGNIZED

FOREVER UNRECOGNIZED

THE TOXIC ICEBERG________________________________________

Oregoniansrsquo HealthOregoniansrsquo Health12 CHEMICALS OF KEY CONCERN12 CHEMICALS OF KEY CONCERN 1048698 1048698 acroleinacrolein 1048698 1048698 benzenebenzene 1048698 1048698 benzo(a)pyrenebenzo(a)pyrene 1048698 1048698 bisphenol-Abisphenol-A 1048698 1048698 brominated flame retardants (BFRs)brominated flame retardants (BFRs) 1048698 1048698 dieseldiesel 1048698 1048698 dioxindioxin 1048698 1048698 formaldehydeformaldehyde 1048698 1048698 leadlead 1048698 1048698 mercurymercury home amp garden pesticideshome amp garden pesticides 1048698 1048698 phthalatesphthalates

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

A 52 yr-old pt co increasing tremor A 52 yr-old pt co increasing tremor On PE the tremor is pill-rolling and On PE the tremor is pill-rolling and resolves with intention +Romberg resolves with intention +Romberg sign unstable tandem gaitsign unstable tandem gait

You make a preliminary diagnosis of You make a preliminary diagnosis of early Parkinsonrsquos diseaseearly Parkinsonrsquos disease

Wife mentions reading about Wife mentions reading about environmental links to PD pt is a environmental links to PD pt is a farmer and has used pesticides for farmer and has used pesticides for years Could this be related to his years Could this be related to his diseasedisease

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

Paraquat rotenone organophosphates Paraquat rotenone organophosphates dieldrin and fungicides maneb amp dieldrin and fungicides maneb amp mancozeb implicatedmancozeb implicated

MPTP a designer heroin-like drug MPTP a designer heroin-like drug causes Parkinsonian syndrome in causes Parkinsonian syndrome in addictsaddicts

Higher incidence in industrialized Higher incidence in industrialized countries greatest risk in rural countries greatest risk in rural areasfarms prolonged pesticide useareasfarms prolonged pesticide use

Case control studies herbicide or Case control studies herbicide or insecticide exposure 3-4x likelyinsecticide exposure 3-4x likely

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

2005 Brown T et al Meta-analysis 2005 Brown T et al Meta-analysis of epidemi-ologic amp toxicologic of epidemi-ologic amp toxicologic studies since 1983 studies since 1983

Verified most of these links noting Verified most of these links noting limitations in study designs limitations in study designs

Conclusion ldquogeneric association btw Conclusion ldquogeneric association btw pesticide exposure amp PD exists but pesticide exposure amp PD exists but is insufficient tohellipconcludehellipa causal is insufficient tohellipconcludehellipa causal relationshiprdquo relationshiprdquo

Pesticides Genes amp PDPesticides Genes amp PD

Dr W Langston of Parkinsonrsquos Dr W Langston of Parkinsonrsquos Institute ldquoAccelerating Research on Institute ldquoAccelerating Research on Genes and Environment in Genes and Environment in Parkinsonrsquos Diseaserdquo (2005)Parkinsonrsquos Diseaserdquo (2005)

Two PD studies underway one in Two PD studies underway one in pesticide applicators other in two pesticide applicators other in two CA counties with known heavy CA counties with known heavy exposureexposure

Other Health Impacts of Other Health Impacts of PesticidesPesticides

ArrhythmiasArrhythmiasAsthmaAsthmaLymphomas Brain tumorsLymphomas Brain tumorsAbnormal sperm countsAbnormal sperm countsBirth defects amp developmental delaysBirth defects amp developmental delaysHyperactivity amp behavioral problemsHyperactivity amp behavioral problemsDecreased endurance amp coordinationDecreased endurance amp coordinationNeurocognitive problemsNeurocognitive problemsPeripheral neuropathiesPeripheral neuropathies

Pesticides a Persistent Pesticides a Persistent ProblemProblem

Major classesMajor classes insecticides fungicides insecticides fungicides herbicides rodenticidesherbicides rodenticides

1997 Market1997 Market US $119 billion World $37 US $119 billion World $37 billionbillion

HistoryHistory synthetic-new to humans amp synthetic-new to humans amp environment since 1940s gt800 licensed environment since 1940s gt800 licensed ldquoactiverdquo ingredientsldquoactiverdquo ingredients

Manufacturers Manufacturers Bayer Aventis other drug Bayer Aventis other drug coco

Inherent toxicityInherent toxicity 140 pesticides considered 140 pesticides considered neurotoxic 37 are used on food ampor feedneurotoxic 37 are used on food ampor feed

Insecticide Sites of Insecticide Sites of ActionAction

Enzymes

Axonal Membranes

Ions (Na+ K+ Ca++ Cl-)

Enzymes

Neurotransmitters

Organochlorines

Pyrethroids

Casarett and Doullrsquos Toxicology The Basic Science of Poisons 5th Edition Ed Klaassen CD

McGraw-Hill New York 1996 P 649

Organophosphorus and

Carbamate Esters

Organophosphate PesticidesOrganophosphate PesticidesOccurrence and distribution in surface amp

ground water of the United States 1992-97

httpgawaterusgsgovpublicationsabstractsofr00-187html

Background Pesticide Background Pesticide Exposures WidespreadExposures Widespread

Reported useReported use 98 of families 80 during 98 of families 80 during pregnancypregnancy

In HumansIn Humans detectable chlorpyrifos detectable chlorpyrifos metabolites in 92 of childrenrsquos 82 of metabolites in 92 of childrenrsquos 82 of adultsrsquo urine samplesadultsrsquo urine samples

In FoodIn Food residues of at least one pesticide on residues of at least one pesticide on 72 fruits amp vegetables72 fruits amp vegetables

In HomesIn Homes 3 to 9 pesticide residues found3 to 9 pesticide residues found

In AirIn Air indoor levels 10-100X higher than indoor levels 10-100X higher than outdooroutdoor

In WaterIn Water gt90 stream samples 50 of gt90 stream samples 50 of wellswells

Sources of PesticidesSources of Pesticides

Household uses lawn amp garden Household uses lawn amp garden sprays exterminators flea collarssprays exterminators flea collars

Household dust (tracking in on shoes)Household dust (tracking in on shoes)

Public schools hospitals parks Public schools hospitals parks childcare facilitieschildcare facilities

Agricultural uses amp workersrsquo clothesAgricultural uses amp workersrsquo clothes

Non-organic foodsNon-organic foods

Breast milkBreast milk

Strategies to Reduces Strategies to Reduces Exposure to Home amp Garden Exposure to Home amp Garden

Pesticides in OregonPesticides in OregonPolicy SolutionsPolicy Solutions OR pesticide use reporting system OR pesticide use reporting system

(1999) finally funded 2005(1999) finally funded 2005 Educate homeowners re nontoxic Educate homeowners re nontoxic

options options Enc pet owners to use flea combs and Enc pet owners to use flea combs and

vacuuming to control fleasvacuuming to control fleas Enc public places to use Integrated Enc public places to use Integrated

Pest Management (IPM) ie Pesticide Pest Management (IPM) ie Pesticide Free ParksFree Parks

What YOU Can Do about What YOU Can Do about PesticidesPesticides

Advise PatientsAdvise Patients Regularly dustRegularly dust Use Integrated Pest Management Use Integrated Pest Management Cleanremove shoes outsideCleanremove shoes outside Keep contaminated clothes separateKeep contaminated clothes separate Buy sustainably grown foodBuy sustainably grown food Store food in secure nontoxic Store food in secure nontoxic

containerscontainers

Mercury amp Women of Mercury amp Women of Childbearing AgeChildbearing Age

A 32 yo G0P0 woman of A 32 yo G0P0 woman of childbearing age (WCBA) childbearing age (WCBA) presents for annual PE presents for annual PE

PMH negativePMH negative

Social hx husband is Social hx husband is recreational fisherman recreational fisherman

Contemplating pregnancy Contemplating pregnancy

Should she avoid fish Should she avoid fish because of mercury risks because of mercury risks to the fetusto the fetus

Mercury amp WCBAMercury amp WCBA

gt10gt10 of WCBA exceed safe limit of of WCBA exceed safe limit of 1ugkgday1ugkgday

5050 of women of women who eat fishwho eat fish exceed exceed limitlimit

5757 of WCBA have Hg levels of WCBA have Hg levels concerning for adverse effects concerning for adverse effects (CDC (CDC Natrsquol Report 0705Natrsquol Report 0705))

Higher risk Higher risk 300 000 childrenyear 300 000 childrenyear subsistence fishers immigrants subsistence fishers immigrants Native AmericansNative Americans

Mercury amp WCBAMercury amp WCBA

Hg enters tissues variable excretionHg enters tissues variable excretion Breast Milk PCBs DDT amp other Breast Milk PCBs DDT amp other

pesticides dioxins dibenzofurans pesticides dioxins dibenzofurans toxic flame retardants amp heavy toxic flame retardants amp heavy metals (Pb amp Hg) metals (Pb amp Hg)

No bio-accumulation in milk but No bio-accumulation in milk but levels in fish-eaters may exceed levels in fish-eaters may exceed unexposed women by 100x unexposed women by 100x

Scientific evidence indicates Scientific evidence indicates advantages of breast-feeding advantages of breast-feeding outweigh riskshellipoutweigh riskshellip

Neuro Effects of MercuryNeuro Effects of Mercury

Cerebral palsyCerebral palsy MRDDMRDD disequilibrium ataxiadisequilibrium ataxia hearing lossdeafnesshearing lossdeafness visual visual

impairmentblindnessimpairmentblindness peripheral neuropathyperipheral neuropathy parasthesiasparasthesias tremors seizures tremors seizures abnl reflexes amp muscle toneabnl reflexes amp muscle tone Psychiatric disturbances Psychiatric disturbances

Mercury a Persistent Mercury a Persistent ProblemProblem

PoisoningsPoisonings Minamata 1950s amp Iraq Minamata 1950s amp Iraq 19711971

Nationally ~Nationally ~160 tons of Hg annually160 tons of Hg annually In OregonIn Oregon ~ ~4500 lbs annually4500 lbs annually Lack of regulationLack of regulation In OR 10 facilities In OR 10 facilities

report Hg release-none has a permit or is report Hg release-none has a permit or is required to monitor emissions by staterequired to monitor emissions by state

Fish AdvisoriesFish Advisories in 2004 45 states had in 2004 45 states had gt2000 warnings Oregon lists advisories gt2000 warnings Oregon lists advisories for 12 water bodies inc Willamette for 12 water bodies inc Willamette

Atmospheric HgAtmospheric Hg

The Mercury CycleThe Mercury Cycle

MercuryMercuryDeclining Threshold of Declining Threshold of

HarmHarm

2000199019801970001

01

1

10

100

YEAR

Level associated with harmful effectRegulatory standard (maximum safe exposure or high end exposure from allowed fish contamination)

FDA WHO

EPA

ATSDR

DA

ILY

IN

TA

KE

(mic

rogr

ams

kg

day

Hg)

Sources of MercurySources of MercuryIndustrial emissions Industrial emissions

coal fired plantscoal fired plantsMunicipal amp medical Municipal amp medical

waste incineratorswaste incineratorsAbandoned Hg amp gold Abandoned Hg amp gold

minesminesNatural off-gassing Natural off-gassing Dental amalgamsDental amalgamsBioaccumulation in Bioaccumulation in

foods esp fishfoods esp fishOld thermometers BP Old thermometers BP

cuffs amp auto cuffs amp auto switchesswitches

Strategies to Reduce Strategies to Reduce Mercury Pollution in Mercury Pollution in

OregonOregonPolicy SolutionsPolicy Solutions Mercury Solutions Act of 2001Mercury Solutions Act of 2001 Ensure safe collection amp recyclingEnsure safe collection amp recycling Clean up abandoned mines and Clean up abandoned mines and

SuperfundsSuperfunds Reduce Hg emissions from health Reduce Hg emissions from health

care facilitiescare facilities Inc Hg in applicable DEQ air amp Inc Hg in applicable DEQ air amp

water permitswater permits Coal burning power plant Boardman Coal burning power plant Boardman

OR OR Implement OR Executive OrderImplement OR Executive Order

What YOU Can Do about What YOU Can Do about MercuryMercury

Advise PatientsAdvise Patients Provide Provide An Expectant Motherrsquos Guide to An Expectant Motherrsquos Guide to

Eating Fish in Oregon (DHS) Eating Fish in Oregon (DHS) in waiting in waiting roomsrooms

Rec WCBA and children avoid fish wHgRec WCBA and children avoid fish wHg Enc WCBA to consume low-fat dietEnc WCBA to consume low-fat diet Recycle old Hg thermometers Recycle old Hg thermometers

thermostats amp fluorescent light tubesthermostats amp fluorescent light tubes Have car checked for Hg switches at Have car checked for Hg switches at

participating auto shop (free participating auto shop (free replacement)replacement)

Use digital thermometers amp thermostatsUse digital thermometers amp thermostats

SummarySummary Chronic Diseases are prevalent Toxic Chronic Diseases are prevalent Toxic

exposures are possible exposures are possible preventablepreventable contributorscontributors

Pesticides amp risk of Parkinsonrsquos and Mercury Pesticides amp risk of Parkinsonrsquos and Mercury risks to WCBA are more understood than most risks to WCBA are more understood than most toxins and other chronic diseasestoxins and other chronic diseases

Apparent toxicity at high doses should be a Apparent toxicity at high doses should be a red flag for possible harm from low dose red flag for possible harm from low dose chronic exposureschronic exposures

Since ldquoproofrdquo of harm materializes slowly Since ldquoproofrdquo of harm materializes slowly generations are at risk and may be harmed generations are at risk and may be harmed before adequate regulatory response occursbefore adequate regulatory response occurs

Kaiser amp HCWHh2eKaiser amp HCWHh2e

Clean Diesel Hospital Zones ProjectClean Diesel Hospital Zones Project Healthy Food in Healthcare InitiativeHealthy Food in Healthcare Initiative Green Building PVC and DEHP free Green Building PVC and DEHP free

NICU NICU Environmentally preferable purchasing Environmentally preferable purchasing

policypolicy Making Medicine Mercury Free Award Making Medicine Mercury Free Award h2e Environmental Leadership Award h2e Environmental Leadership Award

20022002

What Can You DoWhat Can You Do

Be aware of environmental toxins amp Be aware of environmental toxins amp their possible links to chronic diseasestheir possible links to chronic diseases

Provide advice amp education on Provide advice amp education on prevention andor minimizing prevention andor minimizing exposures or refer appropriately exposures or refer appropriately

Incorporate environmental questions Incorporate environmental questions into clinical historyinto clinical history

Advocate Advocate wwwenvirohealthactionorgwwwenvirohealthactionorg

Local AdvocacyLocal Advocacy Oregon Environmental CouncilOregon Environmental Council wwwoeconlineorgwwwoeconlineorg Oregon Collaborative on Health amp Oregon Collaborative on Health amp

EnvironmentEnvironment Healthy Environment ForumsHealthy Environment Forums Oregon Center for Environmental HealthOregon Center for Environmental Health wwworegon-healthorgwwworegon-healthorg Healthcare without HarmHealthcare without Harm Hospitals for Healthy Environment (h2e)Hospitals for Healthy Environment (h2e) Oregon PSROregon PSR wwworegonpsrorgwwworegonpsrorg Environmental Health-In Harmrsquos Way Environmental Health-In Harmrsquos Way

Medical WasteMedical Waste

6000 US hospitals~2 million 6000 US hospitals~2 million tons waste per year tons waste per year

Clinics and doctorsrsquo offices add 700000 Clinics and doctorsrsquo offices add 700000 tonstons

EPA regulations weak-HCWHh2eEPA regulations weak-HCWHh2e 850000 tons incinerated850000 tons incinerated

Pollutants inc dioxin Hg cadmium Pollutants inc dioxin Hg cadmium and Pband Pb

Segregation amp alternatives to Segregation amp alternatives to incineration incineration would cost 93 would cost 93 centspatientdaycentspatientday

Our Chemical EnvironmentOur Chemical Environment

1305 Superfund sites1305 Superfund sites 25002500 are are eligible eligible gt80kgt80k hazardous sites hazardous sites knownknown

~11 million people live within 1 mile~11 million people live within 1 mile ~25 live within 4 miles~25 live within 4 miles OR ranks 24OR ranks 24-12 Superfund sites-12 Superfund sites 3 in PDX3 in PDX Harbor Oil Portland Harbor Oil Portland

Harbor Harbor McCormick amp Baxter McCormick amp Baxter Creosoting Co Creosoting Co

Multnomah amp Washington CoMultnomah amp Washington CoShared Pollutants 2002Shared Pollutants 2002

Links to Disease Links to Disease

Methanol (gt240k lbs)Methanol (gt240k lbs)

StrongStrong ATN amp vision problems ATN amp vision problems

GoodGood Pancreatitis amp Pancreatitis amp Parkinsonrsquosmovement disorders Parkinsonrsquosmovement disorders

Ammonia (gt100k lbs)Ammonia (gt100k lbs)

StrongStrong Asthma acutechronic bronchitis Asthma acutechronic bronchitis olfactory disorders amp rhinitis olfactory disorders amp rhinitis

GoodGood Pulmonary edema Pulmonary edema

Links to Disease contLinks to Disease cont

Xylene (gt95k lbs) amp Toluene (gt83k lbs)Xylene (gt95k lbs) amp Toluene (gt83k lbs) GoodGood Scleroderma arrhythmias menstrual Scleroderma arrhythmias menstrual

do cognitive impairment hearing loss amp do cognitive impairment hearing loss amp fetal death (miscarriagestillbirth)fetal death (miscarriagestillbirth)

Glycol Ethers (gt20k lbs)Glycol Ethers (gt20k lbs) StrongStrong Reduced male fertility abnormal Reduced male fertility abnormal

sperm (morphology motility amp count) amp fetal sperm (morphology motility amp count) amp fetal death (miscarriagestillbirth) death (miscarriagestillbirth)

GoodGood ATN reduced female fertility general ATN reduced female fertility general congenital and craniofacial malformationscongenital and craniofacial malformations

National Report on Human National Report on Human Exposure to Environmental Exposure to Environmental

Chemicals Chemicals (CDC 705)(CDC 705)

Random selection from NHANES Random selection from NHANES surveysurvey

148 chemicals from 2001-2002 inc 148 chemicals from 2001-2002 inc data on 116 chemicals from 1999-data on 116 chemicals from 1999-20002000

Criteria for chemical inclusion Criteria for chemical inclusion wide exposure wide exposure serious health effects serious health effects adequate blood amp urine samples adequate blood amp urine samples efficacy of attempts to reduce efficacy of attempts to reduce

exposure exposure availability of reliable bio-monitoring availability of reliable bio-monitoring

methodmethod

CDC Report GoalsCDC Report Goals

Which chemicals are present amp Which chemicals are present amp concentrations concentrations

How many people have levels above How many people have levels above known toxicity thresholdsknown toxicity thresholds

Establish reference ranges Establish reference ranges Determine if levels are higher in at Determine if levels are higher in at

risk populations risk populations Track trends over time Track trends over time Set priorities for researchSet priorities for research

CDC Report HighlightsCDC Report Highlights

First time data for 38148 chemicalsFirst time data for 38148 chemicals BLL declining 44 of children early BLL declining 44 of children early

1990s 16 of children from 1999-1990s 16 of children from 1999-20022002

Hg in women of childbearing age Hg in women of childbearing age 57 have concerning levels57 have concerning levels

Pyrethroid insecticides (common Pyrethroid insecticides (common home use) 76 of populationhome use) 76 of population

Highlights contHighlights cont

Levels of 3 toxic pesticides- Levels of 3 toxic pesticides- Aldrin Dieldrin amp Endrin-very low Aldrin Dieldrin amp Endrin-very low

29 Dioxin-like compounds levels are 29 Dioxin-like compounds levels are declining declining

Cadmium 5 population gt20yrs age Cadmium 5 population gt20yrs age levels near toxic limit (kidney dz low levels near toxic limit (kidney dz low BMD)BMD)

Phthalates widespread higher in Phthalates widespread higher in women amp childrenwomen amp children

Limitations of Current DataLimitations of Current Data

Exposure to chemical mixtures Exposure to chemical mixtures common-research more complexcommon-research more complex

Data available for only minority Data available for only minority single agentssingle agents

Epidemiological amp animal studies Epidemiological amp animal studies often only data availableoften only data available

Result links btw Chronic Diseases amp Result links btw Chronic Diseases amp low dose chronic complex exposures low dose chronic complex exposures hard to ldquoproverdquohard to ldquoproverdquo

PROVEN HARM

PARTIALLY PROVEN

NOT YET RECOGNIZED

FOREVER UNRECOGNIZED

THE TOXIC ICEBERG________________________________________

Oregoniansrsquo HealthOregoniansrsquo Health12 CHEMICALS OF KEY CONCERN12 CHEMICALS OF KEY CONCERN 1048698 1048698 acroleinacrolein 1048698 1048698 benzenebenzene 1048698 1048698 benzo(a)pyrenebenzo(a)pyrene 1048698 1048698 bisphenol-Abisphenol-A 1048698 1048698 brominated flame retardants (BFRs)brominated flame retardants (BFRs) 1048698 1048698 dieseldiesel 1048698 1048698 dioxindioxin 1048698 1048698 formaldehydeformaldehyde 1048698 1048698 leadlead 1048698 1048698 mercurymercury home amp garden pesticideshome amp garden pesticides 1048698 1048698 phthalatesphthalates

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

A 52 yr-old pt co increasing tremor A 52 yr-old pt co increasing tremor On PE the tremor is pill-rolling and On PE the tremor is pill-rolling and resolves with intention +Romberg resolves with intention +Romberg sign unstable tandem gaitsign unstable tandem gait

You make a preliminary diagnosis of You make a preliminary diagnosis of early Parkinsonrsquos diseaseearly Parkinsonrsquos disease

Wife mentions reading about Wife mentions reading about environmental links to PD pt is a environmental links to PD pt is a farmer and has used pesticides for farmer and has used pesticides for years Could this be related to his years Could this be related to his diseasedisease

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

Paraquat rotenone organophosphates Paraquat rotenone organophosphates dieldrin and fungicides maneb amp dieldrin and fungicides maneb amp mancozeb implicatedmancozeb implicated

MPTP a designer heroin-like drug MPTP a designer heroin-like drug causes Parkinsonian syndrome in causes Parkinsonian syndrome in addictsaddicts

Higher incidence in industrialized Higher incidence in industrialized countries greatest risk in rural countries greatest risk in rural areasfarms prolonged pesticide useareasfarms prolonged pesticide use

Case control studies herbicide or Case control studies herbicide or insecticide exposure 3-4x likelyinsecticide exposure 3-4x likely

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

2005 Brown T et al Meta-analysis 2005 Brown T et al Meta-analysis of epidemi-ologic amp toxicologic of epidemi-ologic amp toxicologic studies since 1983 studies since 1983

Verified most of these links noting Verified most of these links noting limitations in study designs limitations in study designs

Conclusion ldquogeneric association btw Conclusion ldquogeneric association btw pesticide exposure amp PD exists but pesticide exposure amp PD exists but is insufficient tohellipconcludehellipa causal is insufficient tohellipconcludehellipa causal relationshiprdquo relationshiprdquo

Pesticides Genes amp PDPesticides Genes amp PD

Dr W Langston of Parkinsonrsquos Dr W Langston of Parkinsonrsquos Institute ldquoAccelerating Research on Institute ldquoAccelerating Research on Genes and Environment in Genes and Environment in Parkinsonrsquos Diseaserdquo (2005)Parkinsonrsquos Diseaserdquo (2005)

Two PD studies underway one in Two PD studies underway one in pesticide applicators other in two pesticide applicators other in two CA counties with known heavy CA counties with known heavy exposureexposure

Other Health Impacts of Other Health Impacts of PesticidesPesticides

ArrhythmiasArrhythmiasAsthmaAsthmaLymphomas Brain tumorsLymphomas Brain tumorsAbnormal sperm countsAbnormal sperm countsBirth defects amp developmental delaysBirth defects amp developmental delaysHyperactivity amp behavioral problemsHyperactivity amp behavioral problemsDecreased endurance amp coordinationDecreased endurance amp coordinationNeurocognitive problemsNeurocognitive problemsPeripheral neuropathiesPeripheral neuropathies

Pesticides a Persistent Pesticides a Persistent ProblemProblem

Major classesMajor classes insecticides fungicides insecticides fungicides herbicides rodenticidesherbicides rodenticides

1997 Market1997 Market US $119 billion World $37 US $119 billion World $37 billionbillion

HistoryHistory synthetic-new to humans amp synthetic-new to humans amp environment since 1940s gt800 licensed environment since 1940s gt800 licensed ldquoactiverdquo ingredientsldquoactiverdquo ingredients

Manufacturers Manufacturers Bayer Aventis other drug Bayer Aventis other drug coco

Inherent toxicityInherent toxicity 140 pesticides considered 140 pesticides considered neurotoxic 37 are used on food ampor feedneurotoxic 37 are used on food ampor feed

Insecticide Sites of Insecticide Sites of ActionAction

Enzymes

Axonal Membranes

Ions (Na+ K+ Ca++ Cl-)

Enzymes

Neurotransmitters

Organochlorines

Pyrethroids

Casarett and Doullrsquos Toxicology The Basic Science of Poisons 5th Edition Ed Klaassen CD

McGraw-Hill New York 1996 P 649

Organophosphorus and

Carbamate Esters

Organophosphate PesticidesOrganophosphate PesticidesOccurrence and distribution in surface amp

ground water of the United States 1992-97

httpgawaterusgsgovpublicationsabstractsofr00-187html

Background Pesticide Background Pesticide Exposures WidespreadExposures Widespread

Reported useReported use 98 of families 80 during 98 of families 80 during pregnancypregnancy

In HumansIn Humans detectable chlorpyrifos detectable chlorpyrifos metabolites in 92 of childrenrsquos 82 of metabolites in 92 of childrenrsquos 82 of adultsrsquo urine samplesadultsrsquo urine samples

In FoodIn Food residues of at least one pesticide on residues of at least one pesticide on 72 fruits amp vegetables72 fruits amp vegetables

In HomesIn Homes 3 to 9 pesticide residues found3 to 9 pesticide residues found

In AirIn Air indoor levels 10-100X higher than indoor levels 10-100X higher than outdooroutdoor

In WaterIn Water gt90 stream samples 50 of gt90 stream samples 50 of wellswells

Sources of PesticidesSources of Pesticides

Household uses lawn amp garden Household uses lawn amp garden sprays exterminators flea collarssprays exterminators flea collars

Household dust (tracking in on shoes)Household dust (tracking in on shoes)

Public schools hospitals parks Public schools hospitals parks childcare facilitieschildcare facilities

Agricultural uses amp workersrsquo clothesAgricultural uses amp workersrsquo clothes

Non-organic foodsNon-organic foods

Breast milkBreast milk

Strategies to Reduces Strategies to Reduces Exposure to Home amp Garden Exposure to Home amp Garden

Pesticides in OregonPesticides in OregonPolicy SolutionsPolicy Solutions OR pesticide use reporting system OR pesticide use reporting system

(1999) finally funded 2005(1999) finally funded 2005 Educate homeowners re nontoxic Educate homeowners re nontoxic

options options Enc pet owners to use flea combs and Enc pet owners to use flea combs and

vacuuming to control fleasvacuuming to control fleas Enc public places to use Integrated Enc public places to use Integrated

Pest Management (IPM) ie Pesticide Pest Management (IPM) ie Pesticide Free ParksFree Parks

What YOU Can Do about What YOU Can Do about PesticidesPesticides

Advise PatientsAdvise Patients Regularly dustRegularly dust Use Integrated Pest Management Use Integrated Pest Management Cleanremove shoes outsideCleanremove shoes outside Keep contaminated clothes separateKeep contaminated clothes separate Buy sustainably grown foodBuy sustainably grown food Store food in secure nontoxic Store food in secure nontoxic

containerscontainers

Mercury amp Women of Mercury amp Women of Childbearing AgeChildbearing Age

A 32 yo G0P0 woman of A 32 yo G0P0 woman of childbearing age (WCBA) childbearing age (WCBA) presents for annual PE presents for annual PE

PMH negativePMH negative

Social hx husband is Social hx husband is recreational fisherman recreational fisherman

Contemplating pregnancy Contemplating pregnancy

Should she avoid fish Should she avoid fish because of mercury risks because of mercury risks to the fetusto the fetus

Mercury amp WCBAMercury amp WCBA

gt10gt10 of WCBA exceed safe limit of of WCBA exceed safe limit of 1ugkgday1ugkgday

5050 of women of women who eat fishwho eat fish exceed exceed limitlimit

5757 of WCBA have Hg levels of WCBA have Hg levels concerning for adverse effects concerning for adverse effects (CDC (CDC Natrsquol Report 0705Natrsquol Report 0705))

Higher risk Higher risk 300 000 childrenyear 300 000 childrenyear subsistence fishers immigrants subsistence fishers immigrants Native AmericansNative Americans

Mercury amp WCBAMercury amp WCBA

Hg enters tissues variable excretionHg enters tissues variable excretion Breast Milk PCBs DDT amp other Breast Milk PCBs DDT amp other

pesticides dioxins dibenzofurans pesticides dioxins dibenzofurans toxic flame retardants amp heavy toxic flame retardants amp heavy metals (Pb amp Hg) metals (Pb amp Hg)

No bio-accumulation in milk but No bio-accumulation in milk but levels in fish-eaters may exceed levels in fish-eaters may exceed unexposed women by 100x unexposed women by 100x

Scientific evidence indicates Scientific evidence indicates advantages of breast-feeding advantages of breast-feeding outweigh riskshellipoutweigh riskshellip

Neuro Effects of MercuryNeuro Effects of Mercury

Cerebral palsyCerebral palsy MRDDMRDD disequilibrium ataxiadisequilibrium ataxia hearing lossdeafnesshearing lossdeafness visual visual

impairmentblindnessimpairmentblindness peripheral neuropathyperipheral neuropathy parasthesiasparasthesias tremors seizures tremors seizures abnl reflexes amp muscle toneabnl reflexes amp muscle tone Psychiatric disturbances Psychiatric disturbances

Mercury a Persistent Mercury a Persistent ProblemProblem

PoisoningsPoisonings Minamata 1950s amp Iraq Minamata 1950s amp Iraq 19711971

Nationally ~Nationally ~160 tons of Hg annually160 tons of Hg annually In OregonIn Oregon ~ ~4500 lbs annually4500 lbs annually Lack of regulationLack of regulation In OR 10 facilities In OR 10 facilities

report Hg release-none has a permit or is report Hg release-none has a permit or is required to monitor emissions by staterequired to monitor emissions by state

Fish AdvisoriesFish Advisories in 2004 45 states had in 2004 45 states had gt2000 warnings Oregon lists advisories gt2000 warnings Oregon lists advisories for 12 water bodies inc Willamette for 12 water bodies inc Willamette

Atmospheric HgAtmospheric Hg

The Mercury CycleThe Mercury Cycle

MercuryMercuryDeclining Threshold of Declining Threshold of

HarmHarm

2000199019801970001

01

1

10

100

YEAR

Level associated with harmful effectRegulatory standard (maximum safe exposure or high end exposure from allowed fish contamination)

FDA WHO

EPA

ATSDR

DA

ILY

IN

TA

KE

(mic

rogr

ams

kg

day

Hg)

Sources of MercurySources of MercuryIndustrial emissions Industrial emissions

coal fired plantscoal fired plantsMunicipal amp medical Municipal amp medical

waste incineratorswaste incineratorsAbandoned Hg amp gold Abandoned Hg amp gold

minesminesNatural off-gassing Natural off-gassing Dental amalgamsDental amalgamsBioaccumulation in Bioaccumulation in

foods esp fishfoods esp fishOld thermometers BP Old thermometers BP

cuffs amp auto cuffs amp auto switchesswitches

Strategies to Reduce Strategies to Reduce Mercury Pollution in Mercury Pollution in

OregonOregonPolicy SolutionsPolicy Solutions Mercury Solutions Act of 2001Mercury Solutions Act of 2001 Ensure safe collection amp recyclingEnsure safe collection amp recycling Clean up abandoned mines and Clean up abandoned mines and

SuperfundsSuperfunds Reduce Hg emissions from health Reduce Hg emissions from health

care facilitiescare facilities Inc Hg in applicable DEQ air amp Inc Hg in applicable DEQ air amp

water permitswater permits Coal burning power plant Boardman Coal burning power plant Boardman

OR OR Implement OR Executive OrderImplement OR Executive Order

What YOU Can Do about What YOU Can Do about MercuryMercury

Advise PatientsAdvise Patients Provide Provide An Expectant Motherrsquos Guide to An Expectant Motherrsquos Guide to

Eating Fish in Oregon (DHS) Eating Fish in Oregon (DHS) in waiting in waiting roomsrooms

Rec WCBA and children avoid fish wHgRec WCBA and children avoid fish wHg Enc WCBA to consume low-fat dietEnc WCBA to consume low-fat diet Recycle old Hg thermometers Recycle old Hg thermometers

thermostats amp fluorescent light tubesthermostats amp fluorescent light tubes Have car checked for Hg switches at Have car checked for Hg switches at

participating auto shop (free participating auto shop (free replacement)replacement)

Use digital thermometers amp thermostatsUse digital thermometers amp thermostats

SummarySummary Chronic Diseases are prevalent Toxic Chronic Diseases are prevalent Toxic

exposures are possible exposures are possible preventablepreventable contributorscontributors

Pesticides amp risk of Parkinsonrsquos and Mercury Pesticides amp risk of Parkinsonrsquos and Mercury risks to WCBA are more understood than most risks to WCBA are more understood than most toxins and other chronic diseasestoxins and other chronic diseases

Apparent toxicity at high doses should be a Apparent toxicity at high doses should be a red flag for possible harm from low dose red flag for possible harm from low dose chronic exposureschronic exposures

Since ldquoproofrdquo of harm materializes slowly Since ldquoproofrdquo of harm materializes slowly generations are at risk and may be harmed generations are at risk and may be harmed before adequate regulatory response occursbefore adequate regulatory response occurs

Kaiser amp HCWHh2eKaiser amp HCWHh2e

Clean Diesel Hospital Zones ProjectClean Diesel Hospital Zones Project Healthy Food in Healthcare InitiativeHealthy Food in Healthcare Initiative Green Building PVC and DEHP free Green Building PVC and DEHP free

NICU NICU Environmentally preferable purchasing Environmentally preferable purchasing

policypolicy Making Medicine Mercury Free Award Making Medicine Mercury Free Award h2e Environmental Leadership Award h2e Environmental Leadership Award

20022002

What Can You DoWhat Can You Do

Be aware of environmental toxins amp Be aware of environmental toxins amp their possible links to chronic diseasestheir possible links to chronic diseases

Provide advice amp education on Provide advice amp education on prevention andor minimizing prevention andor minimizing exposures or refer appropriately exposures or refer appropriately

Incorporate environmental questions Incorporate environmental questions into clinical historyinto clinical history

Advocate Advocate wwwenvirohealthactionorgwwwenvirohealthactionorg

Local AdvocacyLocal Advocacy Oregon Environmental CouncilOregon Environmental Council wwwoeconlineorgwwwoeconlineorg Oregon Collaborative on Health amp Oregon Collaborative on Health amp

EnvironmentEnvironment Healthy Environment ForumsHealthy Environment Forums Oregon Center for Environmental HealthOregon Center for Environmental Health wwworegon-healthorgwwworegon-healthorg Healthcare without HarmHealthcare without Harm Hospitals for Healthy Environment (h2e)Hospitals for Healthy Environment (h2e) Oregon PSROregon PSR wwworegonpsrorgwwworegonpsrorg Environmental Health-In Harmrsquos Way Environmental Health-In Harmrsquos Way

Our Chemical EnvironmentOur Chemical Environment

1305 Superfund sites1305 Superfund sites 25002500 are are eligible eligible gt80kgt80k hazardous sites hazardous sites knownknown

~11 million people live within 1 mile~11 million people live within 1 mile ~25 live within 4 miles~25 live within 4 miles OR ranks 24OR ranks 24-12 Superfund sites-12 Superfund sites 3 in PDX3 in PDX Harbor Oil Portland Harbor Oil Portland

Harbor Harbor McCormick amp Baxter McCormick amp Baxter Creosoting Co Creosoting Co

Multnomah amp Washington CoMultnomah amp Washington CoShared Pollutants 2002Shared Pollutants 2002

Links to Disease Links to Disease

Methanol (gt240k lbs)Methanol (gt240k lbs)

StrongStrong ATN amp vision problems ATN amp vision problems

GoodGood Pancreatitis amp Pancreatitis amp Parkinsonrsquosmovement disorders Parkinsonrsquosmovement disorders

Ammonia (gt100k lbs)Ammonia (gt100k lbs)

StrongStrong Asthma acutechronic bronchitis Asthma acutechronic bronchitis olfactory disorders amp rhinitis olfactory disorders amp rhinitis

GoodGood Pulmonary edema Pulmonary edema

Links to Disease contLinks to Disease cont

Xylene (gt95k lbs) amp Toluene (gt83k lbs)Xylene (gt95k lbs) amp Toluene (gt83k lbs) GoodGood Scleroderma arrhythmias menstrual Scleroderma arrhythmias menstrual

do cognitive impairment hearing loss amp do cognitive impairment hearing loss amp fetal death (miscarriagestillbirth)fetal death (miscarriagestillbirth)

Glycol Ethers (gt20k lbs)Glycol Ethers (gt20k lbs) StrongStrong Reduced male fertility abnormal Reduced male fertility abnormal

sperm (morphology motility amp count) amp fetal sperm (morphology motility amp count) amp fetal death (miscarriagestillbirth) death (miscarriagestillbirth)

GoodGood ATN reduced female fertility general ATN reduced female fertility general congenital and craniofacial malformationscongenital and craniofacial malformations

National Report on Human National Report on Human Exposure to Environmental Exposure to Environmental

Chemicals Chemicals (CDC 705)(CDC 705)

Random selection from NHANES Random selection from NHANES surveysurvey

148 chemicals from 2001-2002 inc 148 chemicals from 2001-2002 inc data on 116 chemicals from 1999-data on 116 chemicals from 1999-20002000

Criteria for chemical inclusion Criteria for chemical inclusion wide exposure wide exposure serious health effects serious health effects adequate blood amp urine samples adequate blood amp urine samples efficacy of attempts to reduce efficacy of attempts to reduce

exposure exposure availability of reliable bio-monitoring availability of reliable bio-monitoring

methodmethod

CDC Report GoalsCDC Report Goals

Which chemicals are present amp Which chemicals are present amp concentrations concentrations

How many people have levels above How many people have levels above known toxicity thresholdsknown toxicity thresholds

Establish reference ranges Establish reference ranges Determine if levels are higher in at Determine if levels are higher in at

risk populations risk populations Track trends over time Track trends over time Set priorities for researchSet priorities for research

CDC Report HighlightsCDC Report Highlights

First time data for 38148 chemicalsFirst time data for 38148 chemicals BLL declining 44 of children early BLL declining 44 of children early

1990s 16 of children from 1999-1990s 16 of children from 1999-20022002

Hg in women of childbearing age Hg in women of childbearing age 57 have concerning levels57 have concerning levels

Pyrethroid insecticides (common Pyrethroid insecticides (common home use) 76 of populationhome use) 76 of population

Highlights contHighlights cont

Levels of 3 toxic pesticides- Levels of 3 toxic pesticides- Aldrin Dieldrin amp Endrin-very low Aldrin Dieldrin amp Endrin-very low

29 Dioxin-like compounds levels are 29 Dioxin-like compounds levels are declining declining

Cadmium 5 population gt20yrs age Cadmium 5 population gt20yrs age levels near toxic limit (kidney dz low levels near toxic limit (kidney dz low BMD)BMD)

Phthalates widespread higher in Phthalates widespread higher in women amp childrenwomen amp children

Limitations of Current DataLimitations of Current Data

Exposure to chemical mixtures Exposure to chemical mixtures common-research more complexcommon-research more complex

Data available for only minority Data available for only minority single agentssingle agents

Epidemiological amp animal studies Epidemiological amp animal studies often only data availableoften only data available

Result links btw Chronic Diseases amp Result links btw Chronic Diseases amp low dose chronic complex exposures low dose chronic complex exposures hard to ldquoproverdquohard to ldquoproverdquo

PROVEN HARM

PARTIALLY PROVEN

NOT YET RECOGNIZED

FOREVER UNRECOGNIZED

THE TOXIC ICEBERG________________________________________

Oregoniansrsquo HealthOregoniansrsquo Health12 CHEMICALS OF KEY CONCERN12 CHEMICALS OF KEY CONCERN 1048698 1048698 acroleinacrolein 1048698 1048698 benzenebenzene 1048698 1048698 benzo(a)pyrenebenzo(a)pyrene 1048698 1048698 bisphenol-Abisphenol-A 1048698 1048698 brominated flame retardants (BFRs)brominated flame retardants (BFRs) 1048698 1048698 dieseldiesel 1048698 1048698 dioxindioxin 1048698 1048698 formaldehydeformaldehyde 1048698 1048698 leadlead 1048698 1048698 mercurymercury home amp garden pesticideshome amp garden pesticides 1048698 1048698 phthalatesphthalates

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

A 52 yr-old pt co increasing tremor A 52 yr-old pt co increasing tremor On PE the tremor is pill-rolling and On PE the tremor is pill-rolling and resolves with intention +Romberg resolves with intention +Romberg sign unstable tandem gaitsign unstable tandem gait

You make a preliminary diagnosis of You make a preliminary diagnosis of early Parkinsonrsquos diseaseearly Parkinsonrsquos disease

Wife mentions reading about Wife mentions reading about environmental links to PD pt is a environmental links to PD pt is a farmer and has used pesticides for farmer and has used pesticides for years Could this be related to his years Could this be related to his diseasedisease

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

Paraquat rotenone organophosphates Paraquat rotenone organophosphates dieldrin and fungicides maneb amp dieldrin and fungicides maneb amp mancozeb implicatedmancozeb implicated

MPTP a designer heroin-like drug MPTP a designer heroin-like drug causes Parkinsonian syndrome in causes Parkinsonian syndrome in addictsaddicts

Higher incidence in industrialized Higher incidence in industrialized countries greatest risk in rural countries greatest risk in rural areasfarms prolonged pesticide useareasfarms prolonged pesticide use

Case control studies herbicide or Case control studies herbicide or insecticide exposure 3-4x likelyinsecticide exposure 3-4x likely

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

2005 Brown T et al Meta-analysis 2005 Brown T et al Meta-analysis of epidemi-ologic amp toxicologic of epidemi-ologic amp toxicologic studies since 1983 studies since 1983

Verified most of these links noting Verified most of these links noting limitations in study designs limitations in study designs

Conclusion ldquogeneric association btw Conclusion ldquogeneric association btw pesticide exposure amp PD exists but pesticide exposure amp PD exists but is insufficient tohellipconcludehellipa causal is insufficient tohellipconcludehellipa causal relationshiprdquo relationshiprdquo

Pesticides Genes amp PDPesticides Genes amp PD

Dr W Langston of Parkinsonrsquos Dr W Langston of Parkinsonrsquos Institute ldquoAccelerating Research on Institute ldquoAccelerating Research on Genes and Environment in Genes and Environment in Parkinsonrsquos Diseaserdquo (2005)Parkinsonrsquos Diseaserdquo (2005)

Two PD studies underway one in Two PD studies underway one in pesticide applicators other in two pesticide applicators other in two CA counties with known heavy CA counties with known heavy exposureexposure

Other Health Impacts of Other Health Impacts of PesticidesPesticides

ArrhythmiasArrhythmiasAsthmaAsthmaLymphomas Brain tumorsLymphomas Brain tumorsAbnormal sperm countsAbnormal sperm countsBirth defects amp developmental delaysBirth defects amp developmental delaysHyperactivity amp behavioral problemsHyperactivity amp behavioral problemsDecreased endurance amp coordinationDecreased endurance amp coordinationNeurocognitive problemsNeurocognitive problemsPeripheral neuropathiesPeripheral neuropathies

Pesticides a Persistent Pesticides a Persistent ProblemProblem

Major classesMajor classes insecticides fungicides insecticides fungicides herbicides rodenticidesherbicides rodenticides

1997 Market1997 Market US $119 billion World $37 US $119 billion World $37 billionbillion

HistoryHistory synthetic-new to humans amp synthetic-new to humans amp environment since 1940s gt800 licensed environment since 1940s gt800 licensed ldquoactiverdquo ingredientsldquoactiverdquo ingredients

Manufacturers Manufacturers Bayer Aventis other drug Bayer Aventis other drug coco

Inherent toxicityInherent toxicity 140 pesticides considered 140 pesticides considered neurotoxic 37 are used on food ampor feedneurotoxic 37 are used on food ampor feed

Insecticide Sites of Insecticide Sites of ActionAction

Enzymes

Axonal Membranes

Ions (Na+ K+ Ca++ Cl-)

Enzymes

Neurotransmitters

Organochlorines

Pyrethroids

Casarett and Doullrsquos Toxicology The Basic Science of Poisons 5th Edition Ed Klaassen CD

McGraw-Hill New York 1996 P 649

Organophosphorus and

Carbamate Esters

Organophosphate PesticidesOrganophosphate PesticidesOccurrence and distribution in surface amp

ground water of the United States 1992-97

httpgawaterusgsgovpublicationsabstractsofr00-187html

Background Pesticide Background Pesticide Exposures WidespreadExposures Widespread

Reported useReported use 98 of families 80 during 98 of families 80 during pregnancypregnancy

In HumansIn Humans detectable chlorpyrifos detectable chlorpyrifos metabolites in 92 of childrenrsquos 82 of metabolites in 92 of childrenrsquos 82 of adultsrsquo urine samplesadultsrsquo urine samples

In FoodIn Food residues of at least one pesticide on residues of at least one pesticide on 72 fruits amp vegetables72 fruits amp vegetables

In HomesIn Homes 3 to 9 pesticide residues found3 to 9 pesticide residues found

In AirIn Air indoor levels 10-100X higher than indoor levels 10-100X higher than outdooroutdoor

In WaterIn Water gt90 stream samples 50 of gt90 stream samples 50 of wellswells

Sources of PesticidesSources of Pesticides

Household uses lawn amp garden Household uses lawn amp garden sprays exterminators flea collarssprays exterminators flea collars

Household dust (tracking in on shoes)Household dust (tracking in on shoes)

Public schools hospitals parks Public schools hospitals parks childcare facilitieschildcare facilities

Agricultural uses amp workersrsquo clothesAgricultural uses amp workersrsquo clothes

Non-organic foodsNon-organic foods

Breast milkBreast milk

Strategies to Reduces Strategies to Reduces Exposure to Home amp Garden Exposure to Home amp Garden

Pesticides in OregonPesticides in OregonPolicy SolutionsPolicy Solutions OR pesticide use reporting system OR pesticide use reporting system

(1999) finally funded 2005(1999) finally funded 2005 Educate homeowners re nontoxic Educate homeowners re nontoxic

options options Enc pet owners to use flea combs and Enc pet owners to use flea combs and

vacuuming to control fleasvacuuming to control fleas Enc public places to use Integrated Enc public places to use Integrated

Pest Management (IPM) ie Pesticide Pest Management (IPM) ie Pesticide Free ParksFree Parks

What YOU Can Do about What YOU Can Do about PesticidesPesticides

Advise PatientsAdvise Patients Regularly dustRegularly dust Use Integrated Pest Management Use Integrated Pest Management Cleanremove shoes outsideCleanremove shoes outside Keep contaminated clothes separateKeep contaminated clothes separate Buy sustainably grown foodBuy sustainably grown food Store food in secure nontoxic Store food in secure nontoxic

containerscontainers

Mercury amp Women of Mercury amp Women of Childbearing AgeChildbearing Age

A 32 yo G0P0 woman of A 32 yo G0P0 woman of childbearing age (WCBA) childbearing age (WCBA) presents for annual PE presents for annual PE

PMH negativePMH negative

Social hx husband is Social hx husband is recreational fisherman recreational fisherman

Contemplating pregnancy Contemplating pregnancy

Should she avoid fish Should she avoid fish because of mercury risks because of mercury risks to the fetusto the fetus

Mercury amp WCBAMercury amp WCBA

gt10gt10 of WCBA exceed safe limit of of WCBA exceed safe limit of 1ugkgday1ugkgday

5050 of women of women who eat fishwho eat fish exceed exceed limitlimit

5757 of WCBA have Hg levels of WCBA have Hg levels concerning for adverse effects concerning for adverse effects (CDC (CDC Natrsquol Report 0705Natrsquol Report 0705))

Higher risk Higher risk 300 000 childrenyear 300 000 childrenyear subsistence fishers immigrants subsistence fishers immigrants Native AmericansNative Americans

Mercury amp WCBAMercury amp WCBA

Hg enters tissues variable excretionHg enters tissues variable excretion Breast Milk PCBs DDT amp other Breast Milk PCBs DDT amp other

pesticides dioxins dibenzofurans pesticides dioxins dibenzofurans toxic flame retardants amp heavy toxic flame retardants amp heavy metals (Pb amp Hg) metals (Pb amp Hg)

No bio-accumulation in milk but No bio-accumulation in milk but levels in fish-eaters may exceed levels in fish-eaters may exceed unexposed women by 100x unexposed women by 100x

Scientific evidence indicates Scientific evidence indicates advantages of breast-feeding advantages of breast-feeding outweigh riskshellipoutweigh riskshellip

Neuro Effects of MercuryNeuro Effects of Mercury

Cerebral palsyCerebral palsy MRDDMRDD disequilibrium ataxiadisequilibrium ataxia hearing lossdeafnesshearing lossdeafness visual visual

impairmentblindnessimpairmentblindness peripheral neuropathyperipheral neuropathy parasthesiasparasthesias tremors seizures tremors seizures abnl reflexes amp muscle toneabnl reflexes amp muscle tone Psychiatric disturbances Psychiatric disturbances

Mercury a Persistent Mercury a Persistent ProblemProblem

PoisoningsPoisonings Minamata 1950s amp Iraq Minamata 1950s amp Iraq 19711971

Nationally ~Nationally ~160 tons of Hg annually160 tons of Hg annually In OregonIn Oregon ~ ~4500 lbs annually4500 lbs annually Lack of regulationLack of regulation In OR 10 facilities In OR 10 facilities

report Hg release-none has a permit or is report Hg release-none has a permit or is required to monitor emissions by staterequired to monitor emissions by state

Fish AdvisoriesFish Advisories in 2004 45 states had in 2004 45 states had gt2000 warnings Oregon lists advisories gt2000 warnings Oregon lists advisories for 12 water bodies inc Willamette for 12 water bodies inc Willamette

Atmospheric HgAtmospheric Hg

The Mercury CycleThe Mercury Cycle

MercuryMercuryDeclining Threshold of Declining Threshold of

HarmHarm

2000199019801970001

01

1

10

100

YEAR

Level associated with harmful effectRegulatory standard (maximum safe exposure or high end exposure from allowed fish contamination)

FDA WHO

EPA

ATSDR

DA

ILY

IN

TA

KE

(mic

rogr

ams

kg

day

Hg)

Sources of MercurySources of MercuryIndustrial emissions Industrial emissions

coal fired plantscoal fired plantsMunicipal amp medical Municipal amp medical

waste incineratorswaste incineratorsAbandoned Hg amp gold Abandoned Hg amp gold

minesminesNatural off-gassing Natural off-gassing Dental amalgamsDental amalgamsBioaccumulation in Bioaccumulation in

foods esp fishfoods esp fishOld thermometers BP Old thermometers BP

cuffs amp auto cuffs amp auto switchesswitches

Strategies to Reduce Strategies to Reduce Mercury Pollution in Mercury Pollution in

OregonOregonPolicy SolutionsPolicy Solutions Mercury Solutions Act of 2001Mercury Solutions Act of 2001 Ensure safe collection amp recyclingEnsure safe collection amp recycling Clean up abandoned mines and Clean up abandoned mines and

SuperfundsSuperfunds Reduce Hg emissions from health Reduce Hg emissions from health

care facilitiescare facilities Inc Hg in applicable DEQ air amp Inc Hg in applicable DEQ air amp

water permitswater permits Coal burning power plant Boardman Coal burning power plant Boardman

OR OR Implement OR Executive OrderImplement OR Executive Order

What YOU Can Do about What YOU Can Do about MercuryMercury

Advise PatientsAdvise Patients Provide Provide An Expectant Motherrsquos Guide to An Expectant Motherrsquos Guide to

Eating Fish in Oregon (DHS) Eating Fish in Oregon (DHS) in waiting in waiting roomsrooms

Rec WCBA and children avoid fish wHgRec WCBA and children avoid fish wHg Enc WCBA to consume low-fat dietEnc WCBA to consume low-fat diet Recycle old Hg thermometers Recycle old Hg thermometers

thermostats amp fluorescent light tubesthermostats amp fluorescent light tubes Have car checked for Hg switches at Have car checked for Hg switches at

participating auto shop (free participating auto shop (free replacement)replacement)

Use digital thermometers amp thermostatsUse digital thermometers amp thermostats

SummarySummary Chronic Diseases are prevalent Toxic Chronic Diseases are prevalent Toxic

exposures are possible exposures are possible preventablepreventable contributorscontributors

Pesticides amp risk of Parkinsonrsquos and Mercury Pesticides amp risk of Parkinsonrsquos and Mercury risks to WCBA are more understood than most risks to WCBA are more understood than most toxins and other chronic diseasestoxins and other chronic diseases

Apparent toxicity at high doses should be a Apparent toxicity at high doses should be a red flag for possible harm from low dose red flag for possible harm from low dose chronic exposureschronic exposures

Since ldquoproofrdquo of harm materializes slowly Since ldquoproofrdquo of harm materializes slowly generations are at risk and may be harmed generations are at risk and may be harmed before adequate regulatory response occursbefore adequate regulatory response occurs

Kaiser amp HCWHh2eKaiser amp HCWHh2e

Clean Diesel Hospital Zones ProjectClean Diesel Hospital Zones Project Healthy Food in Healthcare InitiativeHealthy Food in Healthcare Initiative Green Building PVC and DEHP free Green Building PVC and DEHP free

NICU NICU Environmentally preferable purchasing Environmentally preferable purchasing

policypolicy Making Medicine Mercury Free Award Making Medicine Mercury Free Award h2e Environmental Leadership Award h2e Environmental Leadership Award

20022002

What Can You DoWhat Can You Do

Be aware of environmental toxins amp Be aware of environmental toxins amp their possible links to chronic diseasestheir possible links to chronic diseases

Provide advice amp education on Provide advice amp education on prevention andor minimizing prevention andor minimizing exposures or refer appropriately exposures or refer appropriately

Incorporate environmental questions Incorporate environmental questions into clinical historyinto clinical history

Advocate Advocate wwwenvirohealthactionorgwwwenvirohealthactionorg

Local AdvocacyLocal Advocacy Oregon Environmental CouncilOregon Environmental Council wwwoeconlineorgwwwoeconlineorg Oregon Collaborative on Health amp Oregon Collaborative on Health amp

EnvironmentEnvironment Healthy Environment ForumsHealthy Environment Forums Oregon Center for Environmental HealthOregon Center for Environmental Health wwworegon-healthorgwwworegon-healthorg Healthcare without HarmHealthcare without Harm Hospitals for Healthy Environment (h2e)Hospitals for Healthy Environment (h2e) Oregon PSROregon PSR wwworegonpsrorgwwworegonpsrorg Environmental Health-In Harmrsquos Way Environmental Health-In Harmrsquos Way

Multnomah amp Washington CoMultnomah amp Washington CoShared Pollutants 2002Shared Pollutants 2002

Links to Disease Links to Disease

Methanol (gt240k lbs)Methanol (gt240k lbs)

StrongStrong ATN amp vision problems ATN amp vision problems

GoodGood Pancreatitis amp Pancreatitis amp Parkinsonrsquosmovement disorders Parkinsonrsquosmovement disorders

Ammonia (gt100k lbs)Ammonia (gt100k lbs)

StrongStrong Asthma acutechronic bronchitis Asthma acutechronic bronchitis olfactory disorders amp rhinitis olfactory disorders amp rhinitis

GoodGood Pulmonary edema Pulmonary edema

Links to Disease contLinks to Disease cont

Xylene (gt95k lbs) amp Toluene (gt83k lbs)Xylene (gt95k lbs) amp Toluene (gt83k lbs) GoodGood Scleroderma arrhythmias menstrual Scleroderma arrhythmias menstrual

do cognitive impairment hearing loss amp do cognitive impairment hearing loss amp fetal death (miscarriagestillbirth)fetal death (miscarriagestillbirth)

Glycol Ethers (gt20k lbs)Glycol Ethers (gt20k lbs) StrongStrong Reduced male fertility abnormal Reduced male fertility abnormal

sperm (morphology motility amp count) amp fetal sperm (morphology motility amp count) amp fetal death (miscarriagestillbirth) death (miscarriagestillbirth)

GoodGood ATN reduced female fertility general ATN reduced female fertility general congenital and craniofacial malformationscongenital and craniofacial malformations

National Report on Human National Report on Human Exposure to Environmental Exposure to Environmental

Chemicals Chemicals (CDC 705)(CDC 705)

Random selection from NHANES Random selection from NHANES surveysurvey

148 chemicals from 2001-2002 inc 148 chemicals from 2001-2002 inc data on 116 chemicals from 1999-data on 116 chemicals from 1999-20002000

Criteria for chemical inclusion Criteria for chemical inclusion wide exposure wide exposure serious health effects serious health effects adequate blood amp urine samples adequate blood amp urine samples efficacy of attempts to reduce efficacy of attempts to reduce

exposure exposure availability of reliable bio-monitoring availability of reliable bio-monitoring

methodmethod

CDC Report GoalsCDC Report Goals

Which chemicals are present amp Which chemicals are present amp concentrations concentrations

How many people have levels above How many people have levels above known toxicity thresholdsknown toxicity thresholds

Establish reference ranges Establish reference ranges Determine if levels are higher in at Determine if levels are higher in at

risk populations risk populations Track trends over time Track trends over time Set priorities for researchSet priorities for research

CDC Report HighlightsCDC Report Highlights

First time data for 38148 chemicalsFirst time data for 38148 chemicals BLL declining 44 of children early BLL declining 44 of children early

1990s 16 of children from 1999-1990s 16 of children from 1999-20022002

Hg in women of childbearing age Hg in women of childbearing age 57 have concerning levels57 have concerning levels

Pyrethroid insecticides (common Pyrethroid insecticides (common home use) 76 of populationhome use) 76 of population

Highlights contHighlights cont

Levels of 3 toxic pesticides- Levels of 3 toxic pesticides- Aldrin Dieldrin amp Endrin-very low Aldrin Dieldrin amp Endrin-very low

29 Dioxin-like compounds levels are 29 Dioxin-like compounds levels are declining declining

Cadmium 5 population gt20yrs age Cadmium 5 population gt20yrs age levels near toxic limit (kidney dz low levels near toxic limit (kidney dz low BMD)BMD)

Phthalates widespread higher in Phthalates widespread higher in women amp childrenwomen amp children

Limitations of Current DataLimitations of Current Data

Exposure to chemical mixtures Exposure to chemical mixtures common-research more complexcommon-research more complex

Data available for only minority Data available for only minority single agentssingle agents

Epidemiological amp animal studies Epidemiological amp animal studies often only data availableoften only data available

Result links btw Chronic Diseases amp Result links btw Chronic Diseases amp low dose chronic complex exposures low dose chronic complex exposures hard to ldquoproverdquohard to ldquoproverdquo

PROVEN HARM

PARTIALLY PROVEN

NOT YET RECOGNIZED

FOREVER UNRECOGNIZED

THE TOXIC ICEBERG________________________________________

Oregoniansrsquo HealthOregoniansrsquo Health12 CHEMICALS OF KEY CONCERN12 CHEMICALS OF KEY CONCERN 1048698 1048698 acroleinacrolein 1048698 1048698 benzenebenzene 1048698 1048698 benzo(a)pyrenebenzo(a)pyrene 1048698 1048698 bisphenol-Abisphenol-A 1048698 1048698 brominated flame retardants (BFRs)brominated flame retardants (BFRs) 1048698 1048698 dieseldiesel 1048698 1048698 dioxindioxin 1048698 1048698 formaldehydeformaldehyde 1048698 1048698 leadlead 1048698 1048698 mercurymercury home amp garden pesticideshome amp garden pesticides 1048698 1048698 phthalatesphthalates

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

A 52 yr-old pt co increasing tremor A 52 yr-old pt co increasing tremor On PE the tremor is pill-rolling and On PE the tremor is pill-rolling and resolves with intention +Romberg resolves with intention +Romberg sign unstable tandem gaitsign unstable tandem gait

You make a preliminary diagnosis of You make a preliminary diagnosis of early Parkinsonrsquos diseaseearly Parkinsonrsquos disease

Wife mentions reading about Wife mentions reading about environmental links to PD pt is a environmental links to PD pt is a farmer and has used pesticides for farmer and has used pesticides for years Could this be related to his years Could this be related to his diseasedisease

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

Paraquat rotenone organophosphates Paraquat rotenone organophosphates dieldrin and fungicides maneb amp dieldrin and fungicides maneb amp mancozeb implicatedmancozeb implicated

MPTP a designer heroin-like drug MPTP a designer heroin-like drug causes Parkinsonian syndrome in causes Parkinsonian syndrome in addictsaddicts

Higher incidence in industrialized Higher incidence in industrialized countries greatest risk in rural countries greatest risk in rural areasfarms prolonged pesticide useareasfarms prolonged pesticide use

Case control studies herbicide or Case control studies herbicide or insecticide exposure 3-4x likelyinsecticide exposure 3-4x likely

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

2005 Brown T et al Meta-analysis 2005 Brown T et al Meta-analysis of epidemi-ologic amp toxicologic of epidemi-ologic amp toxicologic studies since 1983 studies since 1983

Verified most of these links noting Verified most of these links noting limitations in study designs limitations in study designs

Conclusion ldquogeneric association btw Conclusion ldquogeneric association btw pesticide exposure amp PD exists but pesticide exposure amp PD exists but is insufficient tohellipconcludehellipa causal is insufficient tohellipconcludehellipa causal relationshiprdquo relationshiprdquo

Pesticides Genes amp PDPesticides Genes amp PD

Dr W Langston of Parkinsonrsquos Dr W Langston of Parkinsonrsquos Institute ldquoAccelerating Research on Institute ldquoAccelerating Research on Genes and Environment in Genes and Environment in Parkinsonrsquos Diseaserdquo (2005)Parkinsonrsquos Diseaserdquo (2005)

Two PD studies underway one in Two PD studies underway one in pesticide applicators other in two pesticide applicators other in two CA counties with known heavy CA counties with known heavy exposureexposure

Other Health Impacts of Other Health Impacts of PesticidesPesticides

ArrhythmiasArrhythmiasAsthmaAsthmaLymphomas Brain tumorsLymphomas Brain tumorsAbnormal sperm countsAbnormal sperm countsBirth defects amp developmental delaysBirth defects amp developmental delaysHyperactivity amp behavioral problemsHyperactivity amp behavioral problemsDecreased endurance amp coordinationDecreased endurance amp coordinationNeurocognitive problemsNeurocognitive problemsPeripheral neuropathiesPeripheral neuropathies

Pesticides a Persistent Pesticides a Persistent ProblemProblem

Major classesMajor classes insecticides fungicides insecticides fungicides herbicides rodenticidesherbicides rodenticides

1997 Market1997 Market US $119 billion World $37 US $119 billion World $37 billionbillion

HistoryHistory synthetic-new to humans amp synthetic-new to humans amp environment since 1940s gt800 licensed environment since 1940s gt800 licensed ldquoactiverdquo ingredientsldquoactiverdquo ingredients

Manufacturers Manufacturers Bayer Aventis other drug Bayer Aventis other drug coco

Inherent toxicityInherent toxicity 140 pesticides considered 140 pesticides considered neurotoxic 37 are used on food ampor feedneurotoxic 37 are used on food ampor feed

Insecticide Sites of Insecticide Sites of ActionAction

Enzymes

Axonal Membranes

Ions (Na+ K+ Ca++ Cl-)

Enzymes

Neurotransmitters

Organochlorines

Pyrethroids

Casarett and Doullrsquos Toxicology The Basic Science of Poisons 5th Edition Ed Klaassen CD

McGraw-Hill New York 1996 P 649

Organophosphorus and

Carbamate Esters

Organophosphate PesticidesOrganophosphate PesticidesOccurrence and distribution in surface amp

ground water of the United States 1992-97

httpgawaterusgsgovpublicationsabstractsofr00-187html

Background Pesticide Background Pesticide Exposures WidespreadExposures Widespread

Reported useReported use 98 of families 80 during 98 of families 80 during pregnancypregnancy

In HumansIn Humans detectable chlorpyrifos detectable chlorpyrifos metabolites in 92 of childrenrsquos 82 of metabolites in 92 of childrenrsquos 82 of adultsrsquo urine samplesadultsrsquo urine samples

In FoodIn Food residues of at least one pesticide on residues of at least one pesticide on 72 fruits amp vegetables72 fruits amp vegetables

In HomesIn Homes 3 to 9 pesticide residues found3 to 9 pesticide residues found

In AirIn Air indoor levels 10-100X higher than indoor levels 10-100X higher than outdooroutdoor

In WaterIn Water gt90 stream samples 50 of gt90 stream samples 50 of wellswells

Sources of PesticidesSources of Pesticides

Household uses lawn amp garden Household uses lawn amp garden sprays exterminators flea collarssprays exterminators flea collars

Household dust (tracking in on shoes)Household dust (tracking in on shoes)

Public schools hospitals parks Public schools hospitals parks childcare facilitieschildcare facilities

Agricultural uses amp workersrsquo clothesAgricultural uses amp workersrsquo clothes

Non-organic foodsNon-organic foods

Breast milkBreast milk

Strategies to Reduces Strategies to Reduces Exposure to Home amp Garden Exposure to Home amp Garden

Pesticides in OregonPesticides in OregonPolicy SolutionsPolicy Solutions OR pesticide use reporting system OR pesticide use reporting system

(1999) finally funded 2005(1999) finally funded 2005 Educate homeowners re nontoxic Educate homeowners re nontoxic

options options Enc pet owners to use flea combs and Enc pet owners to use flea combs and

vacuuming to control fleasvacuuming to control fleas Enc public places to use Integrated Enc public places to use Integrated

Pest Management (IPM) ie Pesticide Pest Management (IPM) ie Pesticide Free ParksFree Parks

What YOU Can Do about What YOU Can Do about PesticidesPesticides

Advise PatientsAdvise Patients Regularly dustRegularly dust Use Integrated Pest Management Use Integrated Pest Management Cleanremove shoes outsideCleanremove shoes outside Keep contaminated clothes separateKeep contaminated clothes separate Buy sustainably grown foodBuy sustainably grown food Store food in secure nontoxic Store food in secure nontoxic

containerscontainers

Mercury amp Women of Mercury amp Women of Childbearing AgeChildbearing Age

A 32 yo G0P0 woman of A 32 yo G0P0 woman of childbearing age (WCBA) childbearing age (WCBA) presents for annual PE presents for annual PE

PMH negativePMH negative

Social hx husband is Social hx husband is recreational fisherman recreational fisherman

Contemplating pregnancy Contemplating pregnancy

Should she avoid fish Should she avoid fish because of mercury risks because of mercury risks to the fetusto the fetus

Mercury amp WCBAMercury amp WCBA

gt10gt10 of WCBA exceed safe limit of of WCBA exceed safe limit of 1ugkgday1ugkgday

5050 of women of women who eat fishwho eat fish exceed exceed limitlimit

5757 of WCBA have Hg levels of WCBA have Hg levels concerning for adverse effects concerning for adverse effects (CDC (CDC Natrsquol Report 0705Natrsquol Report 0705))

Higher risk Higher risk 300 000 childrenyear 300 000 childrenyear subsistence fishers immigrants subsistence fishers immigrants Native AmericansNative Americans

Mercury amp WCBAMercury amp WCBA

Hg enters tissues variable excretionHg enters tissues variable excretion Breast Milk PCBs DDT amp other Breast Milk PCBs DDT amp other

pesticides dioxins dibenzofurans pesticides dioxins dibenzofurans toxic flame retardants amp heavy toxic flame retardants amp heavy metals (Pb amp Hg) metals (Pb amp Hg)

No bio-accumulation in milk but No bio-accumulation in milk but levels in fish-eaters may exceed levels in fish-eaters may exceed unexposed women by 100x unexposed women by 100x

Scientific evidence indicates Scientific evidence indicates advantages of breast-feeding advantages of breast-feeding outweigh riskshellipoutweigh riskshellip

Neuro Effects of MercuryNeuro Effects of Mercury

Cerebral palsyCerebral palsy MRDDMRDD disequilibrium ataxiadisequilibrium ataxia hearing lossdeafnesshearing lossdeafness visual visual

impairmentblindnessimpairmentblindness peripheral neuropathyperipheral neuropathy parasthesiasparasthesias tremors seizures tremors seizures abnl reflexes amp muscle toneabnl reflexes amp muscle tone Psychiatric disturbances Psychiatric disturbances

Mercury a Persistent Mercury a Persistent ProblemProblem

PoisoningsPoisonings Minamata 1950s amp Iraq Minamata 1950s amp Iraq 19711971

Nationally ~Nationally ~160 tons of Hg annually160 tons of Hg annually In OregonIn Oregon ~ ~4500 lbs annually4500 lbs annually Lack of regulationLack of regulation In OR 10 facilities In OR 10 facilities

report Hg release-none has a permit or is report Hg release-none has a permit or is required to monitor emissions by staterequired to monitor emissions by state

Fish AdvisoriesFish Advisories in 2004 45 states had in 2004 45 states had gt2000 warnings Oregon lists advisories gt2000 warnings Oregon lists advisories for 12 water bodies inc Willamette for 12 water bodies inc Willamette

Atmospheric HgAtmospheric Hg

The Mercury CycleThe Mercury Cycle

MercuryMercuryDeclining Threshold of Declining Threshold of

HarmHarm

2000199019801970001

01

1

10

100

YEAR

Level associated with harmful effectRegulatory standard (maximum safe exposure or high end exposure from allowed fish contamination)

FDA WHO

EPA

ATSDR

DA

ILY

IN

TA

KE

(mic

rogr

ams

kg

day

Hg)

Sources of MercurySources of MercuryIndustrial emissions Industrial emissions

coal fired plantscoal fired plantsMunicipal amp medical Municipal amp medical

waste incineratorswaste incineratorsAbandoned Hg amp gold Abandoned Hg amp gold

minesminesNatural off-gassing Natural off-gassing Dental amalgamsDental amalgamsBioaccumulation in Bioaccumulation in

foods esp fishfoods esp fishOld thermometers BP Old thermometers BP

cuffs amp auto cuffs amp auto switchesswitches

Strategies to Reduce Strategies to Reduce Mercury Pollution in Mercury Pollution in

OregonOregonPolicy SolutionsPolicy Solutions Mercury Solutions Act of 2001Mercury Solutions Act of 2001 Ensure safe collection amp recyclingEnsure safe collection amp recycling Clean up abandoned mines and Clean up abandoned mines and

SuperfundsSuperfunds Reduce Hg emissions from health Reduce Hg emissions from health

care facilitiescare facilities Inc Hg in applicable DEQ air amp Inc Hg in applicable DEQ air amp

water permitswater permits Coal burning power plant Boardman Coal burning power plant Boardman

OR OR Implement OR Executive OrderImplement OR Executive Order

What YOU Can Do about What YOU Can Do about MercuryMercury

Advise PatientsAdvise Patients Provide Provide An Expectant Motherrsquos Guide to An Expectant Motherrsquos Guide to

Eating Fish in Oregon (DHS) Eating Fish in Oregon (DHS) in waiting in waiting roomsrooms

Rec WCBA and children avoid fish wHgRec WCBA and children avoid fish wHg Enc WCBA to consume low-fat dietEnc WCBA to consume low-fat diet Recycle old Hg thermometers Recycle old Hg thermometers

thermostats amp fluorescent light tubesthermostats amp fluorescent light tubes Have car checked for Hg switches at Have car checked for Hg switches at

participating auto shop (free participating auto shop (free replacement)replacement)

Use digital thermometers amp thermostatsUse digital thermometers amp thermostats

SummarySummary Chronic Diseases are prevalent Toxic Chronic Diseases are prevalent Toxic

exposures are possible exposures are possible preventablepreventable contributorscontributors

Pesticides amp risk of Parkinsonrsquos and Mercury Pesticides amp risk of Parkinsonrsquos and Mercury risks to WCBA are more understood than most risks to WCBA are more understood than most toxins and other chronic diseasestoxins and other chronic diseases

Apparent toxicity at high doses should be a Apparent toxicity at high doses should be a red flag for possible harm from low dose red flag for possible harm from low dose chronic exposureschronic exposures

Since ldquoproofrdquo of harm materializes slowly Since ldquoproofrdquo of harm materializes slowly generations are at risk and may be harmed generations are at risk and may be harmed before adequate regulatory response occursbefore adequate regulatory response occurs

Kaiser amp HCWHh2eKaiser amp HCWHh2e

Clean Diesel Hospital Zones ProjectClean Diesel Hospital Zones Project Healthy Food in Healthcare InitiativeHealthy Food in Healthcare Initiative Green Building PVC and DEHP free Green Building PVC and DEHP free

NICU NICU Environmentally preferable purchasing Environmentally preferable purchasing

policypolicy Making Medicine Mercury Free Award Making Medicine Mercury Free Award h2e Environmental Leadership Award h2e Environmental Leadership Award

20022002

What Can You DoWhat Can You Do

Be aware of environmental toxins amp Be aware of environmental toxins amp their possible links to chronic diseasestheir possible links to chronic diseases

Provide advice amp education on Provide advice amp education on prevention andor minimizing prevention andor minimizing exposures or refer appropriately exposures or refer appropriately

Incorporate environmental questions Incorporate environmental questions into clinical historyinto clinical history

Advocate Advocate wwwenvirohealthactionorgwwwenvirohealthactionorg

Local AdvocacyLocal Advocacy Oregon Environmental CouncilOregon Environmental Council wwwoeconlineorgwwwoeconlineorg Oregon Collaborative on Health amp Oregon Collaborative on Health amp

EnvironmentEnvironment Healthy Environment ForumsHealthy Environment Forums Oregon Center for Environmental HealthOregon Center for Environmental Health wwworegon-healthorgwwworegon-healthorg Healthcare without HarmHealthcare without Harm Hospitals for Healthy Environment (h2e)Hospitals for Healthy Environment (h2e) Oregon PSROregon PSR wwworegonpsrorgwwworegonpsrorg Environmental Health-In Harmrsquos Way Environmental Health-In Harmrsquos Way

Links to Disease contLinks to Disease cont

Xylene (gt95k lbs) amp Toluene (gt83k lbs)Xylene (gt95k lbs) amp Toluene (gt83k lbs) GoodGood Scleroderma arrhythmias menstrual Scleroderma arrhythmias menstrual

do cognitive impairment hearing loss amp do cognitive impairment hearing loss amp fetal death (miscarriagestillbirth)fetal death (miscarriagestillbirth)

Glycol Ethers (gt20k lbs)Glycol Ethers (gt20k lbs) StrongStrong Reduced male fertility abnormal Reduced male fertility abnormal

sperm (morphology motility amp count) amp fetal sperm (morphology motility amp count) amp fetal death (miscarriagestillbirth) death (miscarriagestillbirth)

GoodGood ATN reduced female fertility general ATN reduced female fertility general congenital and craniofacial malformationscongenital and craniofacial malformations

National Report on Human National Report on Human Exposure to Environmental Exposure to Environmental

Chemicals Chemicals (CDC 705)(CDC 705)

Random selection from NHANES Random selection from NHANES surveysurvey

148 chemicals from 2001-2002 inc 148 chemicals from 2001-2002 inc data on 116 chemicals from 1999-data on 116 chemicals from 1999-20002000

Criteria for chemical inclusion Criteria for chemical inclusion wide exposure wide exposure serious health effects serious health effects adequate blood amp urine samples adequate blood amp urine samples efficacy of attempts to reduce efficacy of attempts to reduce

exposure exposure availability of reliable bio-monitoring availability of reliable bio-monitoring

methodmethod

CDC Report GoalsCDC Report Goals

Which chemicals are present amp Which chemicals are present amp concentrations concentrations

How many people have levels above How many people have levels above known toxicity thresholdsknown toxicity thresholds

Establish reference ranges Establish reference ranges Determine if levels are higher in at Determine if levels are higher in at

risk populations risk populations Track trends over time Track trends over time Set priorities for researchSet priorities for research

CDC Report HighlightsCDC Report Highlights

First time data for 38148 chemicalsFirst time data for 38148 chemicals BLL declining 44 of children early BLL declining 44 of children early

1990s 16 of children from 1999-1990s 16 of children from 1999-20022002

Hg in women of childbearing age Hg in women of childbearing age 57 have concerning levels57 have concerning levels

Pyrethroid insecticides (common Pyrethroid insecticides (common home use) 76 of populationhome use) 76 of population

Highlights contHighlights cont

Levels of 3 toxic pesticides- Levels of 3 toxic pesticides- Aldrin Dieldrin amp Endrin-very low Aldrin Dieldrin amp Endrin-very low

29 Dioxin-like compounds levels are 29 Dioxin-like compounds levels are declining declining

Cadmium 5 population gt20yrs age Cadmium 5 population gt20yrs age levels near toxic limit (kidney dz low levels near toxic limit (kidney dz low BMD)BMD)

Phthalates widespread higher in Phthalates widespread higher in women amp childrenwomen amp children

Limitations of Current DataLimitations of Current Data

Exposure to chemical mixtures Exposure to chemical mixtures common-research more complexcommon-research more complex

Data available for only minority Data available for only minority single agentssingle agents

Epidemiological amp animal studies Epidemiological amp animal studies often only data availableoften only data available

Result links btw Chronic Diseases amp Result links btw Chronic Diseases amp low dose chronic complex exposures low dose chronic complex exposures hard to ldquoproverdquohard to ldquoproverdquo

PROVEN HARM

PARTIALLY PROVEN

NOT YET RECOGNIZED

FOREVER UNRECOGNIZED

THE TOXIC ICEBERG________________________________________

Oregoniansrsquo HealthOregoniansrsquo Health12 CHEMICALS OF KEY CONCERN12 CHEMICALS OF KEY CONCERN 1048698 1048698 acroleinacrolein 1048698 1048698 benzenebenzene 1048698 1048698 benzo(a)pyrenebenzo(a)pyrene 1048698 1048698 bisphenol-Abisphenol-A 1048698 1048698 brominated flame retardants (BFRs)brominated flame retardants (BFRs) 1048698 1048698 dieseldiesel 1048698 1048698 dioxindioxin 1048698 1048698 formaldehydeformaldehyde 1048698 1048698 leadlead 1048698 1048698 mercurymercury home amp garden pesticideshome amp garden pesticides 1048698 1048698 phthalatesphthalates

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

A 52 yr-old pt co increasing tremor A 52 yr-old pt co increasing tremor On PE the tremor is pill-rolling and On PE the tremor is pill-rolling and resolves with intention +Romberg resolves with intention +Romberg sign unstable tandem gaitsign unstable tandem gait

You make a preliminary diagnosis of You make a preliminary diagnosis of early Parkinsonrsquos diseaseearly Parkinsonrsquos disease

Wife mentions reading about Wife mentions reading about environmental links to PD pt is a environmental links to PD pt is a farmer and has used pesticides for farmer and has used pesticides for years Could this be related to his years Could this be related to his diseasedisease

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

Paraquat rotenone organophosphates Paraquat rotenone organophosphates dieldrin and fungicides maneb amp dieldrin and fungicides maneb amp mancozeb implicatedmancozeb implicated

MPTP a designer heroin-like drug MPTP a designer heroin-like drug causes Parkinsonian syndrome in causes Parkinsonian syndrome in addictsaddicts

Higher incidence in industrialized Higher incidence in industrialized countries greatest risk in rural countries greatest risk in rural areasfarms prolonged pesticide useareasfarms prolonged pesticide use

Case control studies herbicide or Case control studies herbicide or insecticide exposure 3-4x likelyinsecticide exposure 3-4x likely

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

2005 Brown T et al Meta-analysis 2005 Brown T et al Meta-analysis of epidemi-ologic amp toxicologic of epidemi-ologic amp toxicologic studies since 1983 studies since 1983

Verified most of these links noting Verified most of these links noting limitations in study designs limitations in study designs

Conclusion ldquogeneric association btw Conclusion ldquogeneric association btw pesticide exposure amp PD exists but pesticide exposure amp PD exists but is insufficient tohellipconcludehellipa causal is insufficient tohellipconcludehellipa causal relationshiprdquo relationshiprdquo

Pesticides Genes amp PDPesticides Genes amp PD

Dr W Langston of Parkinsonrsquos Dr W Langston of Parkinsonrsquos Institute ldquoAccelerating Research on Institute ldquoAccelerating Research on Genes and Environment in Genes and Environment in Parkinsonrsquos Diseaserdquo (2005)Parkinsonrsquos Diseaserdquo (2005)

Two PD studies underway one in Two PD studies underway one in pesticide applicators other in two pesticide applicators other in two CA counties with known heavy CA counties with known heavy exposureexposure

Other Health Impacts of Other Health Impacts of PesticidesPesticides

ArrhythmiasArrhythmiasAsthmaAsthmaLymphomas Brain tumorsLymphomas Brain tumorsAbnormal sperm countsAbnormal sperm countsBirth defects amp developmental delaysBirth defects amp developmental delaysHyperactivity amp behavioral problemsHyperactivity amp behavioral problemsDecreased endurance amp coordinationDecreased endurance amp coordinationNeurocognitive problemsNeurocognitive problemsPeripheral neuropathiesPeripheral neuropathies

Pesticides a Persistent Pesticides a Persistent ProblemProblem

Major classesMajor classes insecticides fungicides insecticides fungicides herbicides rodenticidesherbicides rodenticides

1997 Market1997 Market US $119 billion World $37 US $119 billion World $37 billionbillion

HistoryHistory synthetic-new to humans amp synthetic-new to humans amp environment since 1940s gt800 licensed environment since 1940s gt800 licensed ldquoactiverdquo ingredientsldquoactiverdquo ingredients

Manufacturers Manufacturers Bayer Aventis other drug Bayer Aventis other drug coco

Inherent toxicityInherent toxicity 140 pesticides considered 140 pesticides considered neurotoxic 37 are used on food ampor feedneurotoxic 37 are used on food ampor feed

Insecticide Sites of Insecticide Sites of ActionAction

Enzymes

Axonal Membranes

Ions (Na+ K+ Ca++ Cl-)

Enzymes

Neurotransmitters

Organochlorines

Pyrethroids

Casarett and Doullrsquos Toxicology The Basic Science of Poisons 5th Edition Ed Klaassen CD

McGraw-Hill New York 1996 P 649

Organophosphorus and

Carbamate Esters

Organophosphate PesticidesOrganophosphate PesticidesOccurrence and distribution in surface amp

ground water of the United States 1992-97

httpgawaterusgsgovpublicationsabstractsofr00-187html

Background Pesticide Background Pesticide Exposures WidespreadExposures Widespread

Reported useReported use 98 of families 80 during 98 of families 80 during pregnancypregnancy

In HumansIn Humans detectable chlorpyrifos detectable chlorpyrifos metabolites in 92 of childrenrsquos 82 of metabolites in 92 of childrenrsquos 82 of adultsrsquo urine samplesadultsrsquo urine samples

In FoodIn Food residues of at least one pesticide on residues of at least one pesticide on 72 fruits amp vegetables72 fruits amp vegetables

In HomesIn Homes 3 to 9 pesticide residues found3 to 9 pesticide residues found

In AirIn Air indoor levels 10-100X higher than indoor levels 10-100X higher than outdooroutdoor

In WaterIn Water gt90 stream samples 50 of gt90 stream samples 50 of wellswells

Sources of PesticidesSources of Pesticides

Household uses lawn amp garden Household uses lawn amp garden sprays exterminators flea collarssprays exterminators flea collars

Household dust (tracking in on shoes)Household dust (tracking in on shoes)

Public schools hospitals parks Public schools hospitals parks childcare facilitieschildcare facilities

Agricultural uses amp workersrsquo clothesAgricultural uses amp workersrsquo clothes

Non-organic foodsNon-organic foods

Breast milkBreast milk

Strategies to Reduces Strategies to Reduces Exposure to Home amp Garden Exposure to Home amp Garden

Pesticides in OregonPesticides in OregonPolicy SolutionsPolicy Solutions OR pesticide use reporting system OR pesticide use reporting system

(1999) finally funded 2005(1999) finally funded 2005 Educate homeowners re nontoxic Educate homeowners re nontoxic

options options Enc pet owners to use flea combs and Enc pet owners to use flea combs and

vacuuming to control fleasvacuuming to control fleas Enc public places to use Integrated Enc public places to use Integrated

Pest Management (IPM) ie Pesticide Pest Management (IPM) ie Pesticide Free ParksFree Parks

What YOU Can Do about What YOU Can Do about PesticidesPesticides

Advise PatientsAdvise Patients Regularly dustRegularly dust Use Integrated Pest Management Use Integrated Pest Management Cleanremove shoes outsideCleanremove shoes outside Keep contaminated clothes separateKeep contaminated clothes separate Buy sustainably grown foodBuy sustainably grown food Store food in secure nontoxic Store food in secure nontoxic

containerscontainers

Mercury amp Women of Mercury amp Women of Childbearing AgeChildbearing Age

A 32 yo G0P0 woman of A 32 yo G0P0 woman of childbearing age (WCBA) childbearing age (WCBA) presents for annual PE presents for annual PE

PMH negativePMH negative

Social hx husband is Social hx husband is recreational fisherman recreational fisherman

Contemplating pregnancy Contemplating pregnancy

Should she avoid fish Should she avoid fish because of mercury risks because of mercury risks to the fetusto the fetus

Mercury amp WCBAMercury amp WCBA

gt10gt10 of WCBA exceed safe limit of of WCBA exceed safe limit of 1ugkgday1ugkgday

5050 of women of women who eat fishwho eat fish exceed exceed limitlimit

5757 of WCBA have Hg levels of WCBA have Hg levels concerning for adverse effects concerning for adverse effects (CDC (CDC Natrsquol Report 0705Natrsquol Report 0705))

Higher risk Higher risk 300 000 childrenyear 300 000 childrenyear subsistence fishers immigrants subsistence fishers immigrants Native AmericansNative Americans

Mercury amp WCBAMercury amp WCBA

Hg enters tissues variable excretionHg enters tissues variable excretion Breast Milk PCBs DDT amp other Breast Milk PCBs DDT amp other

pesticides dioxins dibenzofurans pesticides dioxins dibenzofurans toxic flame retardants amp heavy toxic flame retardants amp heavy metals (Pb amp Hg) metals (Pb amp Hg)

No bio-accumulation in milk but No bio-accumulation in milk but levels in fish-eaters may exceed levels in fish-eaters may exceed unexposed women by 100x unexposed women by 100x

Scientific evidence indicates Scientific evidence indicates advantages of breast-feeding advantages of breast-feeding outweigh riskshellipoutweigh riskshellip

Neuro Effects of MercuryNeuro Effects of Mercury

Cerebral palsyCerebral palsy MRDDMRDD disequilibrium ataxiadisequilibrium ataxia hearing lossdeafnesshearing lossdeafness visual visual

impairmentblindnessimpairmentblindness peripheral neuropathyperipheral neuropathy parasthesiasparasthesias tremors seizures tremors seizures abnl reflexes amp muscle toneabnl reflexes amp muscle tone Psychiatric disturbances Psychiatric disturbances

Mercury a Persistent Mercury a Persistent ProblemProblem

PoisoningsPoisonings Minamata 1950s amp Iraq Minamata 1950s amp Iraq 19711971

Nationally ~Nationally ~160 tons of Hg annually160 tons of Hg annually In OregonIn Oregon ~ ~4500 lbs annually4500 lbs annually Lack of regulationLack of regulation In OR 10 facilities In OR 10 facilities

report Hg release-none has a permit or is report Hg release-none has a permit or is required to monitor emissions by staterequired to monitor emissions by state

Fish AdvisoriesFish Advisories in 2004 45 states had in 2004 45 states had gt2000 warnings Oregon lists advisories gt2000 warnings Oregon lists advisories for 12 water bodies inc Willamette for 12 water bodies inc Willamette

Atmospheric HgAtmospheric Hg

The Mercury CycleThe Mercury Cycle

MercuryMercuryDeclining Threshold of Declining Threshold of

HarmHarm

2000199019801970001

01

1

10

100

YEAR

Level associated with harmful effectRegulatory standard (maximum safe exposure or high end exposure from allowed fish contamination)

FDA WHO

EPA

ATSDR

DA

ILY

IN

TA

KE

(mic

rogr

ams

kg

day

Hg)

Sources of MercurySources of MercuryIndustrial emissions Industrial emissions

coal fired plantscoal fired plantsMunicipal amp medical Municipal amp medical

waste incineratorswaste incineratorsAbandoned Hg amp gold Abandoned Hg amp gold

minesminesNatural off-gassing Natural off-gassing Dental amalgamsDental amalgamsBioaccumulation in Bioaccumulation in

foods esp fishfoods esp fishOld thermometers BP Old thermometers BP

cuffs amp auto cuffs amp auto switchesswitches

Strategies to Reduce Strategies to Reduce Mercury Pollution in Mercury Pollution in

OregonOregonPolicy SolutionsPolicy Solutions Mercury Solutions Act of 2001Mercury Solutions Act of 2001 Ensure safe collection amp recyclingEnsure safe collection amp recycling Clean up abandoned mines and Clean up abandoned mines and

SuperfundsSuperfunds Reduce Hg emissions from health Reduce Hg emissions from health

care facilitiescare facilities Inc Hg in applicable DEQ air amp Inc Hg in applicable DEQ air amp

water permitswater permits Coal burning power plant Boardman Coal burning power plant Boardman

OR OR Implement OR Executive OrderImplement OR Executive Order

What YOU Can Do about What YOU Can Do about MercuryMercury

Advise PatientsAdvise Patients Provide Provide An Expectant Motherrsquos Guide to An Expectant Motherrsquos Guide to

Eating Fish in Oregon (DHS) Eating Fish in Oregon (DHS) in waiting in waiting roomsrooms

Rec WCBA and children avoid fish wHgRec WCBA and children avoid fish wHg Enc WCBA to consume low-fat dietEnc WCBA to consume low-fat diet Recycle old Hg thermometers Recycle old Hg thermometers

thermostats amp fluorescent light tubesthermostats amp fluorescent light tubes Have car checked for Hg switches at Have car checked for Hg switches at

participating auto shop (free participating auto shop (free replacement)replacement)

Use digital thermometers amp thermostatsUse digital thermometers amp thermostats

SummarySummary Chronic Diseases are prevalent Toxic Chronic Diseases are prevalent Toxic

exposures are possible exposures are possible preventablepreventable contributorscontributors

Pesticides amp risk of Parkinsonrsquos and Mercury Pesticides amp risk of Parkinsonrsquos and Mercury risks to WCBA are more understood than most risks to WCBA are more understood than most toxins and other chronic diseasestoxins and other chronic diseases

Apparent toxicity at high doses should be a Apparent toxicity at high doses should be a red flag for possible harm from low dose red flag for possible harm from low dose chronic exposureschronic exposures

Since ldquoproofrdquo of harm materializes slowly Since ldquoproofrdquo of harm materializes slowly generations are at risk and may be harmed generations are at risk and may be harmed before adequate regulatory response occursbefore adequate regulatory response occurs

Kaiser amp HCWHh2eKaiser amp HCWHh2e

Clean Diesel Hospital Zones ProjectClean Diesel Hospital Zones Project Healthy Food in Healthcare InitiativeHealthy Food in Healthcare Initiative Green Building PVC and DEHP free Green Building PVC and DEHP free

NICU NICU Environmentally preferable purchasing Environmentally preferable purchasing

policypolicy Making Medicine Mercury Free Award Making Medicine Mercury Free Award h2e Environmental Leadership Award h2e Environmental Leadership Award

20022002

What Can You DoWhat Can You Do

Be aware of environmental toxins amp Be aware of environmental toxins amp their possible links to chronic diseasestheir possible links to chronic diseases

Provide advice amp education on Provide advice amp education on prevention andor minimizing prevention andor minimizing exposures or refer appropriately exposures or refer appropriately

Incorporate environmental questions Incorporate environmental questions into clinical historyinto clinical history

Advocate Advocate wwwenvirohealthactionorgwwwenvirohealthactionorg

Local AdvocacyLocal Advocacy Oregon Environmental CouncilOregon Environmental Council wwwoeconlineorgwwwoeconlineorg Oregon Collaborative on Health amp Oregon Collaborative on Health amp

EnvironmentEnvironment Healthy Environment ForumsHealthy Environment Forums Oregon Center for Environmental HealthOregon Center for Environmental Health wwworegon-healthorgwwworegon-healthorg Healthcare without HarmHealthcare without Harm Hospitals for Healthy Environment (h2e)Hospitals for Healthy Environment (h2e) Oregon PSROregon PSR wwworegonpsrorgwwworegonpsrorg Environmental Health-In Harmrsquos Way Environmental Health-In Harmrsquos Way

National Report on Human National Report on Human Exposure to Environmental Exposure to Environmental

Chemicals Chemicals (CDC 705)(CDC 705)

Random selection from NHANES Random selection from NHANES surveysurvey

148 chemicals from 2001-2002 inc 148 chemicals from 2001-2002 inc data on 116 chemicals from 1999-data on 116 chemicals from 1999-20002000

Criteria for chemical inclusion Criteria for chemical inclusion wide exposure wide exposure serious health effects serious health effects adequate blood amp urine samples adequate blood amp urine samples efficacy of attempts to reduce efficacy of attempts to reduce

exposure exposure availability of reliable bio-monitoring availability of reliable bio-monitoring

methodmethod

CDC Report GoalsCDC Report Goals

Which chemicals are present amp Which chemicals are present amp concentrations concentrations

How many people have levels above How many people have levels above known toxicity thresholdsknown toxicity thresholds

Establish reference ranges Establish reference ranges Determine if levels are higher in at Determine if levels are higher in at

risk populations risk populations Track trends over time Track trends over time Set priorities for researchSet priorities for research

CDC Report HighlightsCDC Report Highlights

First time data for 38148 chemicalsFirst time data for 38148 chemicals BLL declining 44 of children early BLL declining 44 of children early

1990s 16 of children from 1999-1990s 16 of children from 1999-20022002

Hg in women of childbearing age Hg in women of childbearing age 57 have concerning levels57 have concerning levels

Pyrethroid insecticides (common Pyrethroid insecticides (common home use) 76 of populationhome use) 76 of population

Highlights contHighlights cont

Levels of 3 toxic pesticides- Levels of 3 toxic pesticides- Aldrin Dieldrin amp Endrin-very low Aldrin Dieldrin amp Endrin-very low

29 Dioxin-like compounds levels are 29 Dioxin-like compounds levels are declining declining

Cadmium 5 population gt20yrs age Cadmium 5 population gt20yrs age levels near toxic limit (kidney dz low levels near toxic limit (kidney dz low BMD)BMD)

Phthalates widespread higher in Phthalates widespread higher in women amp childrenwomen amp children

Limitations of Current DataLimitations of Current Data

Exposure to chemical mixtures Exposure to chemical mixtures common-research more complexcommon-research more complex

Data available for only minority Data available for only minority single agentssingle agents

Epidemiological amp animal studies Epidemiological amp animal studies often only data availableoften only data available

Result links btw Chronic Diseases amp Result links btw Chronic Diseases amp low dose chronic complex exposures low dose chronic complex exposures hard to ldquoproverdquohard to ldquoproverdquo

PROVEN HARM

PARTIALLY PROVEN

NOT YET RECOGNIZED

FOREVER UNRECOGNIZED

THE TOXIC ICEBERG________________________________________

Oregoniansrsquo HealthOregoniansrsquo Health12 CHEMICALS OF KEY CONCERN12 CHEMICALS OF KEY CONCERN 1048698 1048698 acroleinacrolein 1048698 1048698 benzenebenzene 1048698 1048698 benzo(a)pyrenebenzo(a)pyrene 1048698 1048698 bisphenol-Abisphenol-A 1048698 1048698 brominated flame retardants (BFRs)brominated flame retardants (BFRs) 1048698 1048698 dieseldiesel 1048698 1048698 dioxindioxin 1048698 1048698 formaldehydeformaldehyde 1048698 1048698 leadlead 1048698 1048698 mercurymercury home amp garden pesticideshome amp garden pesticides 1048698 1048698 phthalatesphthalates

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

A 52 yr-old pt co increasing tremor A 52 yr-old pt co increasing tremor On PE the tremor is pill-rolling and On PE the tremor is pill-rolling and resolves with intention +Romberg resolves with intention +Romberg sign unstable tandem gaitsign unstable tandem gait

You make a preliminary diagnosis of You make a preliminary diagnosis of early Parkinsonrsquos diseaseearly Parkinsonrsquos disease

Wife mentions reading about Wife mentions reading about environmental links to PD pt is a environmental links to PD pt is a farmer and has used pesticides for farmer and has used pesticides for years Could this be related to his years Could this be related to his diseasedisease

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

Paraquat rotenone organophosphates Paraquat rotenone organophosphates dieldrin and fungicides maneb amp dieldrin and fungicides maneb amp mancozeb implicatedmancozeb implicated

MPTP a designer heroin-like drug MPTP a designer heroin-like drug causes Parkinsonian syndrome in causes Parkinsonian syndrome in addictsaddicts

Higher incidence in industrialized Higher incidence in industrialized countries greatest risk in rural countries greatest risk in rural areasfarms prolonged pesticide useareasfarms prolonged pesticide use

Case control studies herbicide or Case control studies herbicide or insecticide exposure 3-4x likelyinsecticide exposure 3-4x likely

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

2005 Brown T et al Meta-analysis 2005 Brown T et al Meta-analysis of epidemi-ologic amp toxicologic of epidemi-ologic amp toxicologic studies since 1983 studies since 1983

Verified most of these links noting Verified most of these links noting limitations in study designs limitations in study designs

Conclusion ldquogeneric association btw Conclusion ldquogeneric association btw pesticide exposure amp PD exists but pesticide exposure amp PD exists but is insufficient tohellipconcludehellipa causal is insufficient tohellipconcludehellipa causal relationshiprdquo relationshiprdquo

Pesticides Genes amp PDPesticides Genes amp PD

Dr W Langston of Parkinsonrsquos Dr W Langston of Parkinsonrsquos Institute ldquoAccelerating Research on Institute ldquoAccelerating Research on Genes and Environment in Genes and Environment in Parkinsonrsquos Diseaserdquo (2005)Parkinsonrsquos Diseaserdquo (2005)

Two PD studies underway one in Two PD studies underway one in pesticide applicators other in two pesticide applicators other in two CA counties with known heavy CA counties with known heavy exposureexposure

Other Health Impacts of Other Health Impacts of PesticidesPesticides

ArrhythmiasArrhythmiasAsthmaAsthmaLymphomas Brain tumorsLymphomas Brain tumorsAbnormal sperm countsAbnormal sperm countsBirth defects amp developmental delaysBirth defects amp developmental delaysHyperactivity amp behavioral problemsHyperactivity amp behavioral problemsDecreased endurance amp coordinationDecreased endurance amp coordinationNeurocognitive problemsNeurocognitive problemsPeripheral neuropathiesPeripheral neuropathies

Pesticides a Persistent Pesticides a Persistent ProblemProblem

Major classesMajor classes insecticides fungicides insecticides fungicides herbicides rodenticidesherbicides rodenticides

1997 Market1997 Market US $119 billion World $37 US $119 billion World $37 billionbillion

HistoryHistory synthetic-new to humans amp synthetic-new to humans amp environment since 1940s gt800 licensed environment since 1940s gt800 licensed ldquoactiverdquo ingredientsldquoactiverdquo ingredients

Manufacturers Manufacturers Bayer Aventis other drug Bayer Aventis other drug coco

Inherent toxicityInherent toxicity 140 pesticides considered 140 pesticides considered neurotoxic 37 are used on food ampor feedneurotoxic 37 are used on food ampor feed

Insecticide Sites of Insecticide Sites of ActionAction

Enzymes

Axonal Membranes

Ions (Na+ K+ Ca++ Cl-)

Enzymes

Neurotransmitters

Organochlorines

Pyrethroids

Casarett and Doullrsquos Toxicology The Basic Science of Poisons 5th Edition Ed Klaassen CD

McGraw-Hill New York 1996 P 649

Organophosphorus and

Carbamate Esters

Organophosphate PesticidesOrganophosphate PesticidesOccurrence and distribution in surface amp

ground water of the United States 1992-97

httpgawaterusgsgovpublicationsabstractsofr00-187html

Background Pesticide Background Pesticide Exposures WidespreadExposures Widespread

Reported useReported use 98 of families 80 during 98 of families 80 during pregnancypregnancy

In HumansIn Humans detectable chlorpyrifos detectable chlorpyrifos metabolites in 92 of childrenrsquos 82 of metabolites in 92 of childrenrsquos 82 of adultsrsquo urine samplesadultsrsquo urine samples

In FoodIn Food residues of at least one pesticide on residues of at least one pesticide on 72 fruits amp vegetables72 fruits amp vegetables

In HomesIn Homes 3 to 9 pesticide residues found3 to 9 pesticide residues found

In AirIn Air indoor levels 10-100X higher than indoor levels 10-100X higher than outdooroutdoor

In WaterIn Water gt90 stream samples 50 of gt90 stream samples 50 of wellswells

Sources of PesticidesSources of Pesticides

Household uses lawn amp garden Household uses lawn amp garden sprays exterminators flea collarssprays exterminators flea collars

Household dust (tracking in on shoes)Household dust (tracking in on shoes)

Public schools hospitals parks Public schools hospitals parks childcare facilitieschildcare facilities

Agricultural uses amp workersrsquo clothesAgricultural uses amp workersrsquo clothes

Non-organic foodsNon-organic foods

Breast milkBreast milk

Strategies to Reduces Strategies to Reduces Exposure to Home amp Garden Exposure to Home amp Garden

Pesticides in OregonPesticides in OregonPolicy SolutionsPolicy Solutions OR pesticide use reporting system OR pesticide use reporting system

(1999) finally funded 2005(1999) finally funded 2005 Educate homeowners re nontoxic Educate homeowners re nontoxic

options options Enc pet owners to use flea combs and Enc pet owners to use flea combs and

vacuuming to control fleasvacuuming to control fleas Enc public places to use Integrated Enc public places to use Integrated

Pest Management (IPM) ie Pesticide Pest Management (IPM) ie Pesticide Free ParksFree Parks

What YOU Can Do about What YOU Can Do about PesticidesPesticides

Advise PatientsAdvise Patients Regularly dustRegularly dust Use Integrated Pest Management Use Integrated Pest Management Cleanremove shoes outsideCleanremove shoes outside Keep contaminated clothes separateKeep contaminated clothes separate Buy sustainably grown foodBuy sustainably grown food Store food in secure nontoxic Store food in secure nontoxic

containerscontainers

Mercury amp Women of Mercury amp Women of Childbearing AgeChildbearing Age

A 32 yo G0P0 woman of A 32 yo G0P0 woman of childbearing age (WCBA) childbearing age (WCBA) presents for annual PE presents for annual PE

PMH negativePMH negative

Social hx husband is Social hx husband is recreational fisherman recreational fisherman

Contemplating pregnancy Contemplating pregnancy

Should she avoid fish Should she avoid fish because of mercury risks because of mercury risks to the fetusto the fetus

Mercury amp WCBAMercury amp WCBA

gt10gt10 of WCBA exceed safe limit of of WCBA exceed safe limit of 1ugkgday1ugkgday

5050 of women of women who eat fishwho eat fish exceed exceed limitlimit

5757 of WCBA have Hg levels of WCBA have Hg levels concerning for adverse effects concerning for adverse effects (CDC (CDC Natrsquol Report 0705Natrsquol Report 0705))

Higher risk Higher risk 300 000 childrenyear 300 000 childrenyear subsistence fishers immigrants subsistence fishers immigrants Native AmericansNative Americans

Mercury amp WCBAMercury amp WCBA

Hg enters tissues variable excretionHg enters tissues variable excretion Breast Milk PCBs DDT amp other Breast Milk PCBs DDT amp other

pesticides dioxins dibenzofurans pesticides dioxins dibenzofurans toxic flame retardants amp heavy toxic flame retardants amp heavy metals (Pb amp Hg) metals (Pb amp Hg)

No bio-accumulation in milk but No bio-accumulation in milk but levels in fish-eaters may exceed levels in fish-eaters may exceed unexposed women by 100x unexposed women by 100x

Scientific evidence indicates Scientific evidence indicates advantages of breast-feeding advantages of breast-feeding outweigh riskshellipoutweigh riskshellip

Neuro Effects of MercuryNeuro Effects of Mercury

Cerebral palsyCerebral palsy MRDDMRDD disequilibrium ataxiadisequilibrium ataxia hearing lossdeafnesshearing lossdeafness visual visual

impairmentblindnessimpairmentblindness peripheral neuropathyperipheral neuropathy parasthesiasparasthesias tremors seizures tremors seizures abnl reflexes amp muscle toneabnl reflexes amp muscle tone Psychiatric disturbances Psychiatric disturbances

Mercury a Persistent Mercury a Persistent ProblemProblem

PoisoningsPoisonings Minamata 1950s amp Iraq Minamata 1950s amp Iraq 19711971

Nationally ~Nationally ~160 tons of Hg annually160 tons of Hg annually In OregonIn Oregon ~ ~4500 lbs annually4500 lbs annually Lack of regulationLack of regulation In OR 10 facilities In OR 10 facilities

report Hg release-none has a permit or is report Hg release-none has a permit or is required to monitor emissions by staterequired to monitor emissions by state

Fish AdvisoriesFish Advisories in 2004 45 states had in 2004 45 states had gt2000 warnings Oregon lists advisories gt2000 warnings Oregon lists advisories for 12 water bodies inc Willamette for 12 water bodies inc Willamette

Atmospheric HgAtmospheric Hg

The Mercury CycleThe Mercury Cycle

MercuryMercuryDeclining Threshold of Declining Threshold of

HarmHarm

2000199019801970001

01

1

10

100

YEAR

Level associated with harmful effectRegulatory standard (maximum safe exposure or high end exposure from allowed fish contamination)

FDA WHO

EPA

ATSDR

DA

ILY

IN

TA

KE

(mic

rogr

ams

kg

day

Hg)

Sources of MercurySources of MercuryIndustrial emissions Industrial emissions

coal fired plantscoal fired plantsMunicipal amp medical Municipal amp medical

waste incineratorswaste incineratorsAbandoned Hg amp gold Abandoned Hg amp gold

minesminesNatural off-gassing Natural off-gassing Dental amalgamsDental amalgamsBioaccumulation in Bioaccumulation in

foods esp fishfoods esp fishOld thermometers BP Old thermometers BP

cuffs amp auto cuffs amp auto switchesswitches

Strategies to Reduce Strategies to Reduce Mercury Pollution in Mercury Pollution in

OregonOregonPolicy SolutionsPolicy Solutions Mercury Solutions Act of 2001Mercury Solutions Act of 2001 Ensure safe collection amp recyclingEnsure safe collection amp recycling Clean up abandoned mines and Clean up abandoned mines and

SuperfundsSuperfunds Reduce Hg emissions from health Reduce Hg emissions from health

care facilitiescare facilities Inc Hg in applicable DEQ air amp Inc Hg in applicable DEQ air amp

water permitswater permits Coal burning power plant Boardman Coal burning power plant Boardman

OR OR Implement OR Executive OrderImplement OR Executive Order

What YOU Can Do about What YOU Can Do about MercuryMercury

Advise PatientsAdvise Patients Provide Provide An Expectant Motherrsquos Guide to An Expectant Motherrsquos Guide to

Eating Fish in Oregon (DHS) Eating Fish in Oregon (DHS) in waiting in waiting roomsrooms

Rec WCBA and children avoid fish wHgRec WCBA and children avoid fish wHg Enc WCBA to consume low-fat dietEnc WCBA to consume low-fat diet Recycle old Hg thermometers Recycle old Hg thermometers

thermostats amp fluorescent light tubesthermostats amp fluorescent light tubes Have car checked for Hg switches at Have car checked for Hg switches at

participating auto shop (free participating auto shop (free replacement)replacement)

Use digital thermometers amp thermostatsUse digital thermometers amp thermostats

SummarySummary Chronic Diseases are prevalent Toxic Chronic Diseases are prevalent Toxic

exposures are possible exposures are possible preventablepreventable contributorscontributors

Pesticides amp risk of Parkinsonrsquos and Mercury Pesticides amp risk of Parkinsonrsquos and Mercury risks to WCBA are more understood than most risks to WCBA are more understood than most toxins and other chronic diseasestoxins and other chronic diseases

Apparent toxicity at high doses should be a Apparent toxicity at high doses should be a red flag for possible harm from low dose red flag for possible harm from low dose chronic exposureschronic exposures

Since ldquoproofrdquo of harm materializes slowly Since ldquoproofrdquo of harm materializes slowly generations are at risk and may be harmed generations are at risk and may be harmed before adequate regulatory response occursbefore adequate regulatory response occurs

Kaiser amp HCWHh2eKaiser amp HCWHh2e

Clean Diesel Hospital Zones ProjectClean Diesel Hospital Zones Project Healthy Food in Healthcare InitiativeHealthy Food in Healthcare Initiative Green Building PVC and DEHP free Green Building PVC and DEHP free

NICU NICU Environmentally preferable purchasing Environmentally preferable purchasing

policypolicy Making Medicine Mercury Free Award Making Medicine Mercury Free Award h2e Environmental Leadership Award h2e Environmental Leadership Award

20022002

What Can You DoWhat Can You Do

Be aware of environmental toxins amp Be aware of environmental toxins amp their possible links to chronic diseasestheir possible links to chronic diseases

Provide advice amp education on Provide advice amp education on prevention andor minimizing prevention andor minimizing exposures or refer appropriately exposures or refer appropriately

Incorporate environmental questions Incorporate environmental questions into clinical historyinto clinical history

Advocate Advocate wwwenvirohealthactionorgwwwenvirohealthactionorg

Local AdvocacyLocal Advocacy Oregon Environmental CouncilOregon Environmental Council wwwoeconlineorgwwwoeconlineorg Oregon Collaborative on Health amp Oregon Collaborative on Health amp

EnvironmentEnvironment Healthy Environment ForumsHealthy Environment Forums Oregon Center for Environmental HealthOregon Center for Environmental Health wwworegon-healthorgwwworegon-healthorg Healthcare without HarmHealthcare without Harm Hospitals for Healthy Environment (h2e)Hospitals for Healthy Environment (h2e) Oregon PSROregon PSR wwworegonpsrorgwwworegonpsrorg Environmental Health-In Harmrsquos Way Environmental Health-In Harmrsquos Way

CDC Report GoalsCDC Report Goals

Which chemicals are present amp Which chemicals are present amp concentrations concentrations

How many people have levels above How many people have levels above known toxicity thresholdsknown toxicity thresholds

Establish reference ranges Establish reference ranges Determine if levels are higher in at Determine if levels are higher in at

risk populations risk populations Track trends over time Track trends over time Set priorities for researchSet priorities for research

CDC Report HighlightsCDC Report Highlights

First time data for 38148 chemicalsFirst time data for 38148 chemicals BLL declining 44 of children early BLL declining 44 of children early

1990s 16 of children from 1999-1990s 16 of children from 1999-20022002

Hg in women of childbearing age Hg in women of childbearing age 57 have concerning levels57 have concerning levels

Pyrethroid insecticides (common Pyrethroid insecticides (common home use) 76 of populationhome use) 76 of population

Highlights contHighlights cont

Levels of 3 toxic pesticides- Levels of 3 toxic pesticides- Aldrin Dieldrin amp Endrin-very low Aldrin Dieldrin amp Endrin-very low

29 Dioxin-like compounds levels are 29 Dioxin-like compounds levels are declining declining

Cadmium 5 population gt20yrs age Cadmium 5 population gt20yrs age levels near toxic limit (kidney dz low levels near toxic limit (kidney dz low BMD)BMD)

Phthalates widespread higher in Phthalates widespread higher in women amp childrenwomen amp children

Limitations of Current DataLimitations of Current Data

Exposure to chemical mixtures Exposure to chemical mixtures common-research more complexcommon-research more complex

Data available for only minority Data available for only minority single agentssingle agents

Epidemiological amp animal studies Epidemiological amp animal studies often only data availableoften only data available

Result links btw Chronic Diseases amp Result links btw Chronic Diseases amp low dose chronic complex exposures low dose chronic complex exposures hard to ldquoproverdquohard to ldquoproverdquo

PROVEN HARM

PARTIALLY PROVEN

NOT YET RECOGNIZED

FOREVER UNRECOGNIZED

THE TOXIC ICEBERG________________________________________

Oregoniansrsquo HealthOregoniansrsquo Health12 CHEMICALS OF KEY CONCERN12 CHEMICALS OF KEY CONCERN 1048698 1048698 acroleinacrolein 1048698 1048698 benzenebenzene 1048698 1048698 benzo(a)pyrenebenzo(a)pyrene 1048698 1048698 bisphenol-Abisphenol-A 1048698 1048698 brominated flame retardants (BFRs)brominated flame retardants (BFRs) 1048698 1048698 dieseldiesel 1048698 1048698 dioxindioxin 1048698 1048698 formaldehydeformaldehyde 1048698 1048698 leadlead 1048698 1048698 mercurymercury home amp garden pesticideshome amp garden pesticides 1048698 1048698 phthalatesphthalates

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

A 52 yr-old pt co increasing tremor A 52 yr-old pt co increasing tremor On PE the tremor is pill-rolling and On PE the tremor is pill-rolling and resolves with intention +Romberg resolves with intention +Romberg sign unstable tandem gaitsign unstable tandem gait

You make a preliminary diagnosis of You make a preliminary diagnosis of early Parkinsonrsquos diseaseearly Parkinsonrsquos disease

Wife mentions reading about Wife mentions reading about environmental links to PD pt is a environmental links to PD pt is a farmer and has used pesticides for farmer and has used pesticides for years Could this be related to his years Could this be related to his diseasedisease

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

Paraquat rotenone organophosphates Paraquat rotenone organophosphates dieldrin and fungicides maneb amp dieldrin and fungicides maneb amp mancozeb implicatedmancozeb implicated

MPTP a designer heroin-like drug MPTP a designer heroin-like drug causes Parkinsonian syndrome in causes Parkinsonian syndrome in addictsaddicts

Higher incidence in industrialized Higher incidence in industrialized countries greatest risk in rural countries greatest risk in rural areasfarms prolonged pesticide useareasfarms prolonged pesticide use

Case control studies herbicide or Case control studies herbicide or insecticide exposure 3-4x likelyinsecticide exposure 3-4x likely

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

2005 Brown T et al Meta-analysis 2005 Brown T et al Meta-analysis of epidemi-ologic amp toxicologic of epidemi-ologic amp toxicologic studies since 1983 studies since 1983

Verified most of these links noting Verified most of these links noting limitations in study designs limitations in study designs

Conclusion ldquogeneric association btw Conclusion ldquogeneric association btw pesticide exposure amp PD exists but pesticide exposure amp PD exists but is insufficient tohellipconcludehellipa causal is insufficient tohellipconcludehellipa causal relationshiprdquo relationshiprdquo

Pesticides Genes amp PDPesticides Genes amp PD

Dr W Langston of Parkinsonrsquos Dr W Langston of Parkinsonrsquos Institute ldquoAccelerating Research on Institute ldquoAccelerating Research on Genes and Environment in Genes and Environment in Parkinsonrsquos Diseaserdquo (2005)Parkinsonrsquos Diseaserdquo (2005)

Two PD studies underway one in Two PD studies underway one in pesticide applicators other in two pesticide applicators other in two CA counties with known heavy CA counties with known heavy exposureexposure

Other Health Impacts of Other Health Impacts of PesticidesPesticides

ArrhythmiasArrhythmiasAsthmaAsthmaLymphomas Brain tumorsLymphomas Brain tumorsAbnormal sperm countsAbnormal sperm countsBirth defects amp developmental delaysBirth defects amp developmental delaysHyperactivity amp behavioral problemsHyperactivity amp behavioral problemsDecreased endurance amp coordinationDecreased endurance amp coordinationNeurocognitive problemsNeurocognitive problemsPeripheral neuropathiesPeripheral neuropathies

Pesticides a Persistent Pesticides a Persistent ProblemProblem

Major classesMajor classes insecticides fungicides insecticides fungicides herbicides rodenticidesherbicides rodenticides

1997 Market1997 Market US $119 billion World $37 US $119 billion World $37 billionbillion

HistoryHistory synthetic-new to humans amp synthetic-new to humans amp environment since 1940s gt800 licensed environment since 1940s gt800 licensed ldquoactiverdquo ingredientsldquoactiverdquo ingredients

Manufacturers Manufacturers Bayer Aventis other drug Bayer Aventis other drug coco

Inherent toxicityInherent toxicity 140 pesticides considered 140 pesticides considered neurotoxic 37 are used on food ampor feedneurotoxic 37 are used on food ampor feed

Insecticide Sites of Insecticide Sites of ActionAction

Enzymes

Axonal Membranes

Ions (Na+ K+ Ca++ Cl-)

Enzymes

Neurotransmitters

Organochlorines

Pyrethroids

Casarett and Doullrsquos Toxicology The Basic Science of Poisons 5th Edition Ed Klaassen CD

McGraw-Hill New York 1996 P 649

Organophosphorus and

Carbamate Esters

Organophosphate PesticidesOrganophosphate PesticidesOccurrence and distribution in surface amp

ground water of the United States 1992-97

httpgawaterusgsgovpublicationsabstractsofr00-187html

Background Pesticide Background Pesticide Exposures WidespreadExposures Widespread

Reported useReported use 98 of families 80 during 98 of families 80 during pregnancypregnancy

In HumansIn Humans detectable chlorpyrifos detectable chlorpyrifos metabolites in 92 of childrenrsquos 82 of metabolites in 92 of childrenrsquos 82 of adultsrsquo urine samplesadultsrsquo urine samples

In FoodIn Food residues of at least one pesticide on residues of at least one pesticide on 72 fruits amp vegetables72 fruits amp vegetables

In HomesIn Homes 3 to 9 pesticide residues found3 to 9 pesticide residues found

In AirIn Air indoor levels 10-100X higher than indoor levels 10-100X higher than outdooroutdoor

In WaterIn Water gt90 stream samples 50 of gt90 stream samples 50 of wellswells

Sources of PesticidesSources of Pesticides

Household uses lawn amp garden Household uses lawn amp garden sprays exterminators flea collarssprays exterminators flea collars

Household dust (tracking in on shoes)Household dust (tracking in on shoes)

Public schools hospitals parks Public schools hospitals parks childcare facilitieschildcare facilities

Agricultural uses amp workersrsquo clothesAgricultural uses amp workersrsquo clothes

Non-organic foodsNon-organic foods

Breast milkBreast milk

Strategies to Reduces Strategies to Reduces Exposure to Home amp Garden Exposure to Home amp Garden

Pesticides in OregonPesticides in OregonPolicy SolutionsPolicy Solutions OR pesticide use reporting system OR pesticide use reporting system

(1999) finally funded 2005(1999) finally funded 2005 Educate homeowners re nontoxic Educate homeowners re nontoxic

options options Enc pet owners to use flea combs and Enc pet owners to use flea combs and

vacuuming to control fleasvacuuming to control fleas Enc public places to use Integrated Enc public places to use Integrated

Pest Management (IPM) ie Pesticide Pest Management (IPM) ie Pesticide Free ParksFree Parks

What YOU Can Do about What YOU Can Do about PesticidesPesticides

Advise PatientsAdvise Patients Regularly dustRegularly dust Use Integrated Pest Management Use Integrated Pest Management Cleanremove shoes outsideCleanremove shoes outside Keep contaminated clothes separateKeep contaminated clothes separate Buy sustainably grown foodBuy sustainably grown food Store food in secure nontoxic Store food in secure nontoxic

containerscontainers

Mercury amp Women of Mercury amp Women of Childbearing AgeChildbearing Age

A 32 yo G0P0 woman of A 32 yo G0P0 woman of childbearing age (WCBA) childbearing age (WCBA) presents for annual PE presents for annual PE

PMH negativePMH negative

Social hx husband is Social hx husband is recreational fisherman recreational fisherman

Contemplating pregnancy Contemplating pregnancy

Should she avoid fish Should she avoid fish because of mercury risks because of mercury risks to the fetusto the fetus

Mercury amp WCBAMercury amp WCBA

gt10gt10 of WCBA exceed safe limit of of WCBA exceed safe limit of 1ugkgday1ugkgday

5050 of women of women who eat fishwho eat fish exceed exceed limitlimit

5757 of WCBA have Hg levels of WCBA have Hg levels concerning for adverse effects concerning for adverse effects (CDC (CDC Natrsquol Report 0705Natrsquol Report 0705))

Higher risk Higher risk 300 000 childrenyear 300 000 childrenyear subsistence fishers immigrants subsistence fishers immigrants Native AmericansNative Americans

Mercury amp WCBAMercury amp WCBA

Hg enters tissues variable excretionHg enters tissues variable excretion Breast Milk PCBs DDT amp other Breast Milk PCBs DDT amp other

pesticides dioxins dibenzofurans pesticides dioxins dibenzofurans toxic flame retardants amp heavy toxic flame retardants amp heavy metals (Pb amp Hg) metals (Pb amp Hg)

No bio-accumulation in milk but No bio-accumulation in milk but levels in fish-eaters may exceed levels in fish-eaters may exceed unexposed women by 100x unexposed women by 100x

Scientific evidence indicates Scientific evidence indicates advantages of breast-feeding advantages of breast-feeding outweigh riskshellipoutweigh riskshellip

Neuro Effects of MercuryNeuro Effects of Mercury

Cerebral palsyCerebral palsy MRDDMRDD disequilibrium ataxiadisequilibrium ataxia hearing lossdeafnesshearing lossdeafness visual visual

impairmentblindnessimpairmentblindness peripheral neuropathyperipheral neuropathy parasthesiasparasthesias tremors seizures tremors seizures abnl reflexes amp muscle toneabnl reflexes amp muscle tone Psychiatric disturbances Psychiatric disturbances

Mercury a Persistent Mercury a Persistent ProblemProblem

PoisoningsPoisonings Minamata 1950s amp Iraq Minamata 1950s amp Iraq 19711971

Nationally ~Nationally ~160 tons of Hg annually160 tons of Hg annually In OregonIn Oregon ~ ~4500 lbs annually4500 lbs annually Lack of regulationLack of regulation In OR 10 facilities In OR 10 facilities

report Hg release-none has a permit or is report Hg release-none has a permit or is required to monitor emissions by staterequired to monitor emissions by state

Fish AdvisoriesFish Advisories in 2004 45 states had in 2004 45 states had gt2000 warnings Oregon lists advisories gt2000 warnings Oregon lists advisories for 12 water bodies inc Willamette for 12 water bodies inc Willamette

Atmospheric HgAtmospheric Hg

The Mercury CycleThe Mercury Cycle

MercuryMercuryDeclining Threshold of Declining Threshold of

HarmHarm

2000199019801970001

01

1

10

100

YEAR

Level associated with harmful effectRegulatory standard (maximum safe exposure or high end exposure from allowed fish contamination)

FDA WHO

EPA

ATSDR

DA

ILY

IN

TA

KE

(mic

rogr

ams

kg

day

Hg)

Sources of MercurySources of MercuryIndustrial emissions Industrial emissions

coal fired plantscoal fired plantsMunicipal amp medical Municipal amp medical

waste incineratorswaste incineratorsAbandoned Hg amp gold Abandoned Hg amp gold

minesminesNatural off-gassing Natural off-gassing Dental amalgamsDental amalgamsBioaccumulation in Bioaccumulation in

foods esp fishfoods esp fishOld thermometers BP Old thermometers BP

cuffs amp auto cuffs amp auto switchesswitches

Strategies to Reduce Strategies to Reduce Mercury Pollution in Mercury Pollution in

OregonOregonPolicy SolutionsPolicy Solutions Mercury Solutions Act of 2001Mercury Solutions Act of 2001 Ensure safe collection amp recyclingEnsure safe collection amp recycling Clean up abandoned mines and Clean up abandoned mines and

SuperfundsSuperfunds Reduce Hg emissions from health Reduce Hg emissions from health

care facilitiescare facilities Inc Hg in applicable DEQ air amp Inc Hg in applicable DEQ air amp

water permitswater permits Coal burning power plant Boardman Coal burning power plant Boardman

OR OR Implement OR Executive OrderImplement OR Executive Order

What YOU Can Do about What YOU Can Do about MercuryMercury

Advise PatientsAdvise Patients Provide Provide An Expectant Motherrsquos Guide to An Expectant Motherrsquos Guide to

Eating Fish in Oregon (DHS) Eating Fish in Oregon (DHS) in waiting in waiting roomsrooms

Rec WCBA and children avoid fish wHgRec WCBA and children avoid fish wHg Enc WCBA to consume low-fat dietEnc WCBA to consume low-fat diet Recycle old Hg thermometers Recycle old Hg thermometers

thermostats amp fluorescent light tubesthermostats amp fluorescent light tubes Have car checked for Hg switches at Have car checked for Hg switches at

participating auto shop (free participating auto shop (free replacement)replacement)

Use digital thermometers amp thermostatsUse digital thermometers amp thermostats

SummarySummary Chronic Diseases are prevalent Toxic Chronic Diseases are prevalent Toxic

exposures are possible exposures are possible preventablepreventable contributorscontributors

Pesticides amp risk of Parkinsonrsquos and Mercury Pesticides amp risk of Parkinsonrsquos and Mercury risks to WCBA are more understood than most risks to WCBA are more understood than most toxins and other chronic diseasestoxins and other chronic diseases

Apparent toxicity at high doses should be a Apparent toxicity at high doses should be a red flag for possible harm from low dose red flag for possible harm from low dose chronic exposureschronic exposures

Since ldquoproofrdquo of harm materializes slowly Since ldquoproofrdquo of harm materializes slowly generations are at risk and may be harmed generations are at risk and may be harmed before adequate regulatory response occursbefore adequate regulatory response occurs

Kaiser amp HCWHh2eKaiser amp HCWHh2e

Clean Diesel Hospital Zones ProjectClean Diesel Hospital Zones Project Healthy Food in Healthcare InitiativeHealthy Food in Healthcare Initiative Green Building PVC and DEHP free Green Building PVC and DEHP free

NICU NICU Environmentally preferable purchasing Environmentally preferable purchasing

policypolicy Making Medicine Mercury Free Award Making Medicine Mercury Free Award h2e Environmental Leadership Award h2e Environmental Leadership Award

20022002

What Can You DoWhat Can You Do

Be aware of environmental toxins amp Be aware of environmental toxins amp their possible links to chronic diseasestheir possible links to chronic diseases

Provide advice amp education on Provide advice amp education on prevention andor minimizing prevention andor minimizing exposures or refer appropriately exposures or refer appropriately

Incorporate environmental questions Incorporate environmental questions into clinical historyinto clinical history

Advocate Advocate wwwenvirohealthactionorgwwwenvirohealthactionorg

Local AdvocacyLocal Advocacy Oregon Environmental CouncilOregon Environmental Council wwwoeconlineorgwwwoeconlineorg Oregon Collaborative on Health amp Oregon Collaborative on Health amp

EnvironmentEnvironment Healthy Environment ForumsHealthy Environment Forums Oregon Center for Environmental HealthOregon Center for Environmental Health wwworegon-healthorgwwworegon-healthorg Healthcare without HarmHealthcare without Harm Hospitals for Healthy Environment (h2e)Hospitals for Healthy Environment (h2e) Oregon PSROregon PSR wwworegonpsrorgwwworegonpsrorg Environmental Health-In Harmrsquos Way Environmental Health-In Harmrsquos Way

CDC Report HighlightsCDC Report Highlights

First time data for 38148 chemicalsFirst time data for 38148 chemicals BLL declining 44 of children early BLL declining 44 of children early

1990s 16 of children from 1999-1990s 16 of children from 1999-20022002

Hg in women of childbearing age Hg in women of childbearing age 57 have concerning levels57 have concerning levels

Pyrethroid insecticides (common Pyrethroid insecticides (common home use) 76 of populationhome use) 76 of population

Highlights contHighlights cont

Levels of 3 toxic pesticides- Levels of 3 toxic pesticides- Aldrin Dieldrin amp Endrin-very low Aldrin Dieldrin amp Endrin-very low

29 Dioxin-like compounds levels are 29 Dioxin-like compounds levels are declining declining

Cadmium 5 population gt20yrs age Cadmium 5 population gt20yrs age levels near toxic limit (kidney dz low levels near toxic limit (kidney dz low BMD)BMD)

Phthalates widespread higher in Phthalates widespread higher in women amp childrenwomen amp children

Limitations of Current DataLimitations of Current Data

Exposure to chemical mixtures Exposure to chemical mixtures common-research more complexcommon-research more complex

Data available for only minority Data available for only minority single agentssingle agents

Epidemiological amp animal studies Epidemiological amp animal studies often only data availableoften only data available

Result links btw Chronic Diseases amp Result links btw Chronic Diseases amp low dose chronic complex exposures low dose chronic complex exposures hard to ldquoproverdquohard to ldquoproverdquo

PROVEN HARM

PARTIALLY PROVEN

NOT YET RECOGNIZED

FOREVER UNRECOGNIZED

THE TOXIC ICEBERG________________________________________

Oregoniansrsquo HealthOregoniansrsquo Health12 CHEMICALS OF KEY CONCERN12 CHEMICALS OF KEY CONCERN 1048698 1048698 acroleinacrolein 1048698 1048698 benzenebenzene 1048698 1048698 benzo(a)pyrenebenzo(a)pyrene 1048698 1048698 bisphenol-Abisphenol-A 1048698 1048698 brominated flame retardants (BFRs)brominated flame retardants (BFRs) 1048698 1048698 dieseldiesel 1048698 1048698 dioxindioxin 1048698 1048698 formaldehydeformaldehyde 1048698 1048698 leadlead 1048698 1048698 mercurymercury home amp garden pesticideshome amp garden pesticides 1048698 1048698 phthalatesphthalates

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

A 52 yr-old pt co increasing tremor A 52 yr-old pt co increasing tremor On PE the tremor is pill-rolling and On PE the tremor is pill-rolling and resolves with intention +Romberg resolves with intention +Romberg sign unstable tandem gaitsign unstable tandem gait

You make a preliminary diagnosis of You make a preliminary diagnosis of early Parkinsonrsquos diseaseearly Parkinsonrsquos disease

Wife mentions reading about Wife mentions reading about environmental links to PD pt is a environmental links to PD pt is a farmer and has used pesticides for farmer and has used pesticides for years Could this be related to his years Could this be related to his diseasedisease

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

Paraquat rotenone organophosphates Paraquat rotenone organophosphates dieldrin and fungicides maneb amp dieldrin and fungicides maneb amp mancozeb implicatedmancozeb implicated

MPTP a designer heroin-like drug MPTP a designer heroin-like drug causes Parkinsonian syndrome in causes Parkinsonian syndrome in addictsaddicts

Higher incidence in industrialized Higher incidence in industrialized countries greatest risk in rural countries greatest risk in rural areasfarms prolonged pesticide useareasfarms prolonged pesticide use

Case control studies herbicide or Case control studies herbicide or insecticide exposure 3-4x likelyinsecticide exposure 3-4x likely

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

2005 Brown T et al Meta-analysis 2005 Brown T et al Meta-analysis of epidemi-ologic amp toxicologic of epidemi-ologic amp toxicologic studies since 1983 studies since 1983

Verified most of these links noting Verified most of these links noting limitations in study designs limitations in study designs

Conclusion ldquogeneric association btw Conclusion ldquogeneric association btw pesticide exposure amp PD exists but pesticide exposure amp PD exists but is insufficient tohellipconcludehellipa causal is insufficient tohellipconcludehellipa causal relationshiprdquo relationshiprdquo

Pesticides Genes amp PDPesticides Genes amp PD

Dr W Langston of Parkinsonrsquos Dr W Langston of Parkinsonrsquos Institute ldquoAccelerating Research on Institute ldquoAccelerating Research on Genes and Environment in Genes and Environment in Parkinsonrsquos Diseaserdquo (2005)Parkinsonrsquos Diseaserdquo (2005)

Two PD studies underway one in Two PD studies underway one in pesticide applicators other in two pesticide applicators other in two CA counties with known heavy CA counties with known heavy exposureexposure

Other Health Impacts of Other Health Impacts of PesticidesPesticides

ArrhythmiasArrhythmiasAsthmaAsthmaLymphomas Brain tumorsLymphomas Brain tumorsAbnormal sperm countsAbnormal sperm countsBirth defects amp developmental delaysBirth defects amp developmental delaysHyperactivity amp behavioral problemsHyperactivity amp behavioral problemsDecreased endurance amp coordinationDecreased endurance amp coordinationNeurocognitive problemsNeurocognitive problemsPeripheral neuropathiesPeripheral neuropathies

Pesticides a Persistent Pesticides a Persistent ProblemProblem

Major classesMajor classes insecticides fungicides insecticides fungicides herbicides rodenticidesherbicides rodenticides

1997 Market1997 Market US $119 billion World $37 US $119 billion World $37 billionbillion

HistoryHistory synthetic-new to humans amp synthetic-new to humans amp environment since 1940s gt800 licensed environment since 1940s gt800 licensed ldquoactiverdquo ingredientsldquoactiverdquo ingredients

Manufacturers Manufacturers Bayer Aventis other drug Bayer Aventis other drug coco

Inherent toxicityInherent toxicity 140 pesticides considered 140 pesticides considered neurotoxic 37 are used on food ampor feedneurotoxic 37 are used on food ampor feed

Insecticide Sites of Insecticide Sites of ActionAction

Enzymes

Axonal Membranes

Ions (Na+ K+ Ca++ Cl-)

Enzymes

Neurotransmitters

Organochlorines

Pyrethroids

Casarett and Doullrsquos Toxicology The Basic Science of Poisons 5th Edition Ed Klaassen CD

McGraw-Hill New York 1996 P 649

Organophosphorus and

Carbamate Esters

Organophosphate PesticidesOrganophosphate PesticidesOccurrence and distribution in surface amp

ground water of the United States 1992-97

httpgawaterusgsgovpublicationsabstractsofr00-187html

Background Pesticide Background Pesticide Exposures WidespreadExposures Widespread

Reported useReported use 98 of families 80 during 98 of families 80 during pregnancypregnancy

In HumansIn Humans detectable chlorpyrifos detectable chlorpyrifos metabolites in 92 of childrenrsquos 82 of metabolites in 92 of childrenrsquos 82 of adultsrsquo urine samplesadultsrsquo urine samples

In FoodIn Food residues of at least one pesticide on residues of at least one pesticide on 72 fruits amp vegetables72 fruits amp vegetables

In HomesIn Homes 3 to 9 pesticide residues found3 to 9 pesticide residues found

In AirIn Air indoor levels 10-100X higher than indoor levels 10-100X higher than outdooroutdoor

In WaterIn Water gt90 stream samples 50 of gt90 stream samples 50 of wellswells

Sources of PesticidesSources of Pesticides

Household uses lawn amp garden Household uses lawn amp garden sprays exterminators flea collarssprays exterminators flea collars

Household dust (tracking in on shoes)Household dust (tracking in on shoes)

Public schools hospitals parks Public schools hospitals parks childcare facilitieschildcare facilities

Agricultural uses amp workersrsquo clothesAgricultural uses amp workersrsquo clothes

Non-organic foodsNon-organic foods

Breast milkBreast milk

Strategies to Reduces Strategies to Reduces Exposure to Home amp Garden Exposure to Home amp Garden

Pesticides in OregonPesticides in OregonPolicy SolutionsPolicy Solutions OR pesticide use reporting system OR pesticide use reporting system

(1999) finally funded 2005(1999) finally funded 2005 Educate homeowners re nontoxic Educate homeowners re nontoxic

options options Enc pet owners to use flea combs and Enc pet owners to use flea combs and

vacuuming to control fleasvacuuming to control fleas Enc public places to use Integrated Enc public places to use Integrated

Pest Management (IPM) ie Pesticide Pest Management (IPM) ie Pesticide Free ParksFree Parks

What YOU Can Do about What YOU Can Do about PesticidesPesticides

Advise PatientsAdvise Patients Regularly dustRegularly dust Use Integrated Pest Management Use Integrated Pest Management Cleanremove shoes outsideCleanremove shoes outside Keep contaminated clothes separateKeep contaminated clothes separate Buy sustainably grown foodBuy sustainably grown food Store food in secure nontoxic Store food in secure nontoxic

containerscontainers

Mercury amp Women of Mercury amp Women of Childbearing AgeChildbearing Age

A 32 yo G0P0 woman of A 32 yo G0P0 woman of childbearing age (WCBA) childbearing age (WCBA) presents for annual PE presents for annual PE

PMH negativePMH negative

Social hx husband is Social hx husband is recreational fisherman recreational fisherman

Contemplating pregnancy Contemplating pregnancy

Should she avoid fish Should she avoid fish because of mercury risks because of mercury risks to the fetusto the fetus

Mercury amp WCBAMercury amp WCBA

gt10gt10 of WCBA exceed safe limit of of WCBA exceed safe limit of 1ugkgday1ugkgday

5050 of women of women who eat fishwho eat fish exceed exceed limitlimit

5757 of WCBA have Hg levels of WCBA have Hg levels concerning for adverse effects concerning for adverse effects (CDC (CDC Natrsquol Report 0705Natrsquol Report 0705))

Higher risk Higher risk 300 000 childrenyear 300 000 childrenyear subsistence fishers immigrants subsistence fishers immigrants Native AmericansNative Americans

Mercury amp WCBAMercury amp WCBA

Hg enters tissues variable excretionHg enters tissues variable excretion Breast Milk PCBs DDT amp other Breast Milk PCBs DDT amp other

pesticides dioxins dibenzofurans pesticides dioxins dibenzofurans toxic flame retardants amp heavy toxic flame retardants amp heavy metals (Pb amp Hg) metals (Pb amp Hg)

No bio-accumulation in milk but No bio-accumulation in milk but levels in fish-eaters may exceed levels in fish-eaters may exceed unexposed women by 100x unexposed women by 100x

Scientific evidence indicates Scientific evidence indicates advantages of breast-feeding advantages of breast-feeding outweigh riskshellipoutweigh riskshellip

Neuro Effects of MercuryNeuro Effects of Mercury

Cerebral palsyCerebral palsy MRDDMRDD disequilibrium ataxiadisequilibrium ataxia hearing lossdeafnesshearing lossdeafness visual visual

impairmentblindnessimpairmentblindness peripheral neuropathyperipheral neuropathy parasthesiasparasthesias tremors seizures tremors seizures abnl reflexes amp muscle toneabnl reflexes amp muscle tone Psychiatric disturbances Psychiatric disturbances

Mercury a Persistent Mercury a Persistent ProblemProblem

PoisoningsPoisonings Minamata 1950s amp Iraq Minamata 1950s amp Iraq 19711971

Nationally ~Nationally ~160 tons of Hg annually160 tons of Hg annually In OregonIn Oregon ~ ~4500 lbs annually4500 lbs annually Lack of regulationLack of regulation In OR 10 facilities In OR 10 facilities

report Hg release-none has a permit or is report Hg release-none has a permit or is required to monitor emissions by staterequired to monitor emissions by state

Fish AdvisoriesFish Advisories in 2004 45 states had in 2004 45 states had gt2000 warnings Oregon lists advisories gt2000 warnings Oregon lists advisories for 12 water bodies inc Willamette for 12 water bodies inc Willamette

Atmospheric HgAtmospheric Hg

The Mercury CycleThe Mercury Cycle

MercuryMercuryDeclining Threshold of Declining Threshold of

HarmHarm

2000199019801970001

01

1

10

100

YEAR

Level associated with harmful effectRegulatory standard (maximum safe exposure or high end exposure from allowed fish contamination)

FDA WHO

EPA

ATSDR

DA

ILY

IN

TA

KE

(mic

rogr

ams

kg

day

Hg)

Sources of MercurySources of MercuryIndustrial emissions Industrial emissions

coal fired plantscoal fired plantsMunicipal amp medical Municipal amp medical

waste incineratorswaste incineratorsAbandoned Hg amp gold Abandoned Hg amp gold

minesminesNatural off-gassing Natural off-gassing Dental amalgamsDental amalgamsBioaccumulation in Bioaccumulation in

foods esp fishfoods esp fishOld thermometers BP Old thermometers BP

cuffs amp auto cuffs amp auto switchesswitches

Strategies to Reduce Strategies to Reduce Mercury Pollution in Mercury Pollution in

OregonOregonPolicy SolutionsPolicy Solutions Mercury Solutions Act of 2001Mercury Solutions Act of 2001 Ensure safe collection amp recyclingEnsure safe collection amp recycling Clean up abandoned mines and Clean up abandoned mines and

SuperfundsSuperfunds Reduce Hg emissions from health Reduce Hg emissions from health

care facilitiescare facilities Inc Hg in applicable DEQ air amp Inc Hg in applicable DEQ air amp

water permitswater permits Coal burning power plant Boardman Coal burning power plant Boardman

OR OR Implement OR Executive OrderImplement OR Executive Order

What YOU Can Do about What YOU Can Do about MercuryMercury

Advise PatientsAdvise Patients Provide Provide An Expectant Motherrsquos Guide to An Expectant Motherrsquos Guide to

Eating Fish in Oregon (DHS) Eating Fish in Oregon (DHS) in waiting in waiting roomsrooms

Rec WCBA and children avoid fish wHgRec WCBA and children avoid fish wHg Enc WCBA to consume low-fat dietEnc WCBA to consume low-fat diet Recycle old Hg thermometers Recycle old Hg thermometers

thermostats amp fluorescent light tubesthermostats amp fluorescent light tubes Have car checked for Hg switches at Have car checked for Hg switches at

participating auto shop (free participating auto shop (free replacement)replacement)

Use digital thermometers amp thermostatsUse digital thermometers amp thermostats

SummarySummary Chronic Diseases are prevalent Toxic Chronic Diseases are prevalent Toxic

exposures are possible exposures are possible preventablepreventable contributorscontributors

Pesticides amp risk of Parkinsonrsquos and Mercury Pesticides amp risk of Parkinsonrsquos and Mercury risks to WCBA are more understood than most risks to WCBA are more understood than most toxins and other chronic diseasestoxins and other chronic diseases

Apparent toxicity at high doses should be a Apparent toxicity at high doses should be a red flag for possible harm from low dose red flag for possible harm from low dose chronic exposureschronic exposures

Since ldquoproofrdquo of harm materializes slowly Since ldquoproofrdquo of harm materializes slowly generations are at risk and may be harmed generations are at risk and may be harmed before adequate regulatory response occursbefore adequate regulatory response occurs

Kaiser amp HCWHh2eKaiser amp HCWHh2e

Clean Diesel Hospital Zones ProjectClean Diesel Hospital Zones Project Healthy Food in Healthcare InitiativeHealthy Food in Healthcare Initiative Green Building PVC and DEHP free Green Building PVC and DEHP free

NICU NICU Environmentally preferable purchasing Environmentally preferable purchasing

policypolicy Making Medicine Mercury Free Award Making Medicine Mercury Free Award h2e Environmental Leadership Award h2e Environmental Leadership Award

20022002

What Can You DoWhat Can You Do

Be aware of environmental toxins amp Be aware of environmental toxins amp their possible links to chronic diseasestheir possible links to chronic diseases

Provide advice amp education on Provide advice amp education on prevention andor minimizing prevention andor minimizing exposures or refer appropriately exposures or refer appropriately

Incorporate environmental questions Incorporate environmental questions into clinical historyinto clinical history

Advocate Advocate wwwenvirohealthactionorgwwwenvirohealthactionorg

Local AdvocacyLocal Advocacy Oregon Environmental CouncilOregon Environmental Council wwwoeconlineorgwwwoeconlineorg Oregon Collaborative on Health amp Oregon Collaborative on Health amp

EnvironmentEnvironment Healthy Environment ForumsHealthy Environment Forums Oregon Center for Environmental HealthOregon Center for Environmental Health wwworegon-healthorgwwworegon-healthorg Healthcare without HarmHealthcare without Harm Hospitals for Healthy Environment (h2e)Hospitals for Healthy Environment (h2e) Oregon PSROregon PSR wwworegonpsrorgwwworegonpsrorg Environmental Health-In Harmrsquos Way Environmental Health-In Harmrsquos Way

Highlights contHighlights cont

Levels of 3 toxic pesticides- Levels of 3 toxic pesticides- Aldrin Dieldrin amp Endrin-very low Aldrin Dieldrin amp Endrin-very low

29 Dioxin-like compounds levels are 29 Dioxin-like compounds levels are declining declining

Cadmium 5 population gt20yrs age Cadmium 5 population gt20yrs age levels near toxic limit (kidney dz low levels near toxic limit (kidney dz low BMD)BMD)

Phthalates widespread higher in Phthalates widespread higher in women amp childrenwomen amp children

Limitations of Current DataLimitations of Current Data

Exposure to chemical mixtures Exposure to chemical mixtures common-research more complexcommon-research more complex

Data available for only minority Data available for only minority single agentssingle agents

Epidemiological amp animal studies Epidemiological amp animal studies often only data availableoften only data available

Result links btw Chronic Diseases amp Result links btw Chronic Diseases amp low dose chronic complex exposures low dose chronic complex exposures hard to ldquoproverdquohard to ldquoproverdquo

PROVEN HARM

PARTIALLY PROVEN

NOT YET RECOGNIZED

FOREVER UNRECOGNIZED

THE TOXIC ICEBERG________________________________________

Oregoniansrsquo HealthOregoniansrsquo Health12 CHEMICALS OF KEY CONCERN12 CHEMICALS OF KEY CONCERN 1048698 1048698 acroleinacrolein 1048698 1048698 benzenebenzene 1048698 1048698 benzo(a)pyrenebenzo(a)pyrene 1048698 1048698 bisphenol-Abisphenol-A 1048698 1048698 brominated flame retardants (BFRs)brominated flame retardants (BFRs) 1048698 1048698 dieseldiesel 1048698 1048698 dioxindioxin 1048698 1048698 formaldehydeformaldehyde 1048698 1048698 leadlead 1048698 1048698 mercurymercury home amp garden pesticideshome amp garden pesticides 1048698 1048698 phthalatesphthalates

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

A 52 yr-old pt co increasing tremor A 52 yr-old pt co increasing tremor On PE the tremor is pill-rolling and On PE the tremor is pill-rolling and resolves with intention +Romberg resolves with intention +Romberg sign unstable tandem gaitsign unstable tandem gait

You make a preliminary diagnosis of You make a preliminary diagnosis of early Parkinsonrsquos diseaseearly Parkinsonrsquos disease

Wife mentions reading about Wife mentions reading about environmental links to PD pt is a environmental links to PD pt is a farmer and has used pesticides for farmer and has used pesticides for years Could this be related to his years Could this be related to his diseasedisease

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

Paraquat rotenone organophosphates Paraquat rotenone organophosphates dieldrin and fungicides maneb amp dieldrin and fungicides maneb amp mancozeb implicatedmancozeb implicated

MPTP a designer heroin-like drug MPTP a designer heroin-like drug causes Parkinsonian syndrome in causes Parkinsonian syndrome in addictsaddicts

Higher incidence in industrialized Higher incidence in industrialized countries greatest risk in rural countries greatest risk in rural areasfarms prolonged pesticide useareasfarms prolonged pesticide use

Case control studies herbicide or Case control studies herbicide or insecticide exposure 3-4x likelyinsecticide exposure 3-4x likely

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

2005 Brown T et al Meta-analysis 2005 Brown T et al Meta-analysis of epidemi-ologic amp toxicologic of epidemi-ologic amp toxicologic studies since 1983 studies since 1983

Verified most of these links noting Verified most of these links noting limitations in study designs limitations in study designs

Conclusion ldquogeneric association btw Conclusion ldquogeneric association btw pesticide exposure amp PD exists but pesticide exposure amp PD exists but is insufficient tohellipconcludehellipa causal is insufficient tohellipconcludehellipa causal relationshiprdquo relationshiprdquo

Pesticides Genes amp PDPesticides Genes amp PD

Dr W Langston of Parkinsonrsquos Dr W Langston of Parkinsonrsquos Institute ldquoAccelerating Research on Institute ldquoAccelerating Research on Genes and Environment in Genes and Environment in Parkinsonrsquos Diseaserdquo (2005)Parkinsonrsquos Diseaserdquo (2005)

Two PD studies underway one in Two PD studies underway one in pesticide applicators other in two pesticide applicators other in two CA counties with known heavy CA counties with known heavy exposureexposure

Other Health Impacts of Other Health Impacts of PesticidesPesticides

ArrhythmiasArrhythmiasAsthmaAsthmaLymphomas Brain tumorsLymphomas Brain tumorsAbnormal sperm countsAbnormal sperm countsBirth defects amp developmental delaysBirth defects amp developmental delaysHyperactivity amp behavioral problemsHyperactivity amp behavioral problemsDecreased endurance amp coordinationDecreased endurance amp coordinationNeurocognitive problemsNeurocognitive problemsPeripheral neuropathiesPeripheral neuropathies

Pesticides a Persistent Pesticides a Persistent ProblemProblem

Major classesMajor classes insecticides fungicides insecticides fungicides herbicides rodenticidesherbicides rodenticides

1997 Market1997 Market US $119 billion World $37 US $119 billion World $37 billionbillion

HistoryHistory synthetic-new to humans amp synthetic-new to humans amp environment since 1940s gt800 licensed environment since 1940s gt800 licensed ldquoactiverdquo ingredientsldquoactiverdquo ingredients

Manufacturers Manufacturers Bayer Aventis other drug Bayer Aventis other drug coco

Inherent toxicityInherent toxicity 140 pesticides considered 140 pesticides considered neurotoxic 37 are used on food ampor feedneurotoxic 37 are used on food ampor feed

Insecticide Sites of Insecticide Sites of ActionAction

Enzymes

Axonal Membranes

Ions (Na+ K+ Ca++ Cl-)

Enzymes

Neurotransmitters

Organochlorines

Pyrethroids

Casarett and Doullrsquos Toxicology The Basic Science of Poisons 5th Edition Ed Klaassen CD

McGraw-Hill New York 1996 P 649

Organophosphorus and

Carbamate Esters

Organophosphate PesticidesOrganophosphate PesticidesOccurrence and distribution in surface amp

ground water of the United States 1992-97

httpgawaterusgsgovpublicationsabstractsofr00-187html

Background Pesticide Background Pesticide Exposures WidespreadExposures Widespread

Reported useReported use 98 of families 80 during 98 of families 80 during pregnancypregnancy

In HumansIn Humans detectable chlorpyrifos detectable chlorpyrifos metabolites in 92 of childrenrsquos 82 of metabolites in 92 of childrenrsquos 82 of adultsrsquo urine samplesadultsrsquo urine samples

In FoodIn Food residues of at least one pesticide on residues of at least one pesticide on 72 fruits amp vegetables72 fruits amp vegetables

In HomesIn Homes 3 to 9 pesticide residues found3 to 9 pesticide residues found

In AirIn Air indoor levels 10-100X higher than indoor levels 10-100X higher than outdooroutdoor

In WaterIn Water gt90 stream samples 50 of gt90 stream samples 50 of wellswells

Sources of PesticidesSources of Pesticides

Household uses lawn amp garden Household uses lawn amp garden sprays exterminators flea collarssprays exterminators flea collars

Household dust (tracking in on shoes)Household dust (tracking in on shoes)

Public schools hospitals parks Public schools hospitals parks childcare facilitieschildcare facilities

Agricultural uses amp workersrsquo clothesAgricultural uses amp workersrsquo clothes

Non-organic foodsNon-organic foods

Breast milkBreast milk

Strategies to Reduces Strategies to Reduces Exposure to Home amp Garden Exposure to Home amp Garden

Pesticides in OregonPesticides in OregonPolicy SolutionsPolicy Solutions OR pesticide use reporting system OR pesticide use reporting system

(1999) finally funded 2005(1999) finally funded 2005 Educate homeowners re nontoxic Educate homeowners re nontoxic

options options Enc pet owners to use flea combs and Enc pet owners to use flea combs and

vacuuming to control fleasvacuuming to control fleas Enc public places to use Integrated Enc public places to use Integrated

Pest Management (IPM) ie Pesticide Pest Management (IPM) ie Pesticide Free ParksFree Parks

What YOU Can Do about What YOU Can Do about PesticidesPesticides

Advise PatientsAdvise Patients Regularly dustRegularly dust Use Integrated Pest Management Use Integrated Pest Management Cleanremove shoes outsideCleanremove shoes outside Keep contaminated clothes separateKeep contaminated clothes separate Buy sustainably grown foodBuy sustainably grown food Store food in secure nontoxic Store food in secure nontoxic

containerscontainers

Mercury amp Women of Mercury amp Women of Childbearing AgeChildbearing Age

A 32 yo G0P0 woman of A 32 yo G0P0 woman of childbearing age (WCBA) childbearing age (WCBA) presents for annual PE presents for annual PE

PMH negativePMH negative

Social hx husband is Social hx husband is recreational fisherman recreational fisherman

Contemplating pregnancy Contemplating pregnancy

Should she avoid fish Should she avoid fish because of mercury risks because of mercury risks to the fetusto the fetus

Mercury amp WCBAMercury amp WCBA

gt10gt10 of WCBA exceed safe limit of of WCBA exceed safe limit of 1ugkgday1ugkgday

5050 of women of women who eat fishwho eat fish exceed exceed limitlimit

5757 of WCBA have Hg levels of WCBA have Hg levels concerning for adverse effects concerning for adverse effects (CDC (CDC Natrsquol Report 0705Natrsquol Report 0705))

Higher risk Higher risk 300 000 childrenyear 300 000 childrenyear subsistence fishers immigrants subsistence fishers immigrants Native AmericansNative Americans

Mercury amp WCBAMercury amp WCBA

Hg enters tissues variable excretionHg enters tissues variable excretion Breast Milk PCBs DDT amp other Breast Milk PCBs DDT amp other

pesticides dioxins dibenzofurans pesticides dioxins dibenzofurans toxic flame retardants amp heavy toxic flame retardants amp heavy metals (Pb amp Hg) metals (Pb amp Hg)

No bio-accumulation in milk but No bio-accumulation in milk but levels in fish-eaters may exceed levels in fish-eaters may exceed unexposed women by 100x unexposed women by 100x

Scientific evidence indicates Scientific evidence indicates advantages of breast-feeding advantages of breast-feeding outweigh riskshellipoutweigh riskshellip

Neuro Effects of MercuryNeuro Effects of Mercury

Cerebral palsyCerebral palsy MRDDMRDD disequilibrium ataxiadisequilibrium ataxia hearing lossdeafnesshearing lossdeafness visual visual

impairmentblindnessimpairmentblindness peripheral neuropathyperipheral neuropathy parasthesiasparasthesias tremors seizures tremors seizures abnl reflexes amp muscle toneabnl reflexes amp muscle tone Psychiatric disturbances Psychiatric disturbances

Mercury a Persistent Mercury a Persistent ProblemProblem

PoisoningsPoisonings Minamata 1950s amp Iraq Minamata 1950s amp Iraq 19711971

Nationally ~Nationally ~160 tons of Hg annually160 tons of Hg annually In OregonIn Oregon ~ ~4500 lbs annually4500 lbs annually Lack of regulationLack of regulation In OR 10 facilities In OR 10 facilities

report Hg release-none has a permit or is report Hg release-none has a permit or is required to monitor emissions by staterequired to monitor emissions by state

Fish AdvisoriesFish Advisories in 2004 45 states had in 2004 45 states had gt2000 warnings Oregon lists advisories gt2000 warnings Oregon lists advisories for 12 water bodies inc Willamette for 12 water bodies inc Willamette

Atmospheric HgAtmospheric Hg

The Mercury CycleThe Mercury Cycle

MercuryMercuryDeclining Threshold of Declining Threshold of

HarmHarm

2000199019801970001

01

1

10

100

YEAR

Level associated with harmful effectRegulatory standard (maximum safe exposure or high end exposure from allowed fish contamination)

FDA WHO

EPA

ATSDR

DA

ILY

IN

TA

KE

(mic

rogr

ams

kg

day

Hg)

Sources of MercurySources of MercuryIndustrial emissions Industrial emissions

coal fired plantscoal fired plantsMunicipal amp medical Municipal amp medical

waste incineratorswaste incineratorsAbandoned Hg amp gold Abandoned Hg amp gold

minesminesNatural off-gassing Natural off-gassing Dental amalgamsDental amalgamsBioaccumulation in Bioaccumulation in

foods esp fishfoods esp fishOld thermometers BP Old thermometers BP

cuffs amp auto cuffs amp auto switchesswitches

Strategies to Reduce Strategies to Reduce Mercury Pollution in Mercury Pollution in

OregonOregonPolicy SolutionsPolicy Solutions Mercury Solutions Act of 2001Mercury Solutions Act of 2001 Ensure safe collection amp recyclingEnsure safe collection amp recycling Clean up abandoned mines and Clean up abandoned mines and

SuperfundsSuperfunds Reduce Hg emissions from health Reduce Hg emissions from health

care facilitiescare facilities Inc Hg in applicable DEQ air amp Inc Hg in applicable DEQ air amp

water permitswater permits Coal burning power plant Boardman Coal burning power plant Boardman

OR OR Implement OR Executive OrderImplement OR Executive Order

What YOU Can Do about What YOU Can Do about MercuryMercury

Advise PatientsAdvise Patients Provide Provide An Expectant Motherrsquos Guide to An Expectant Motherrsquos Guide to

Eating Fish in Oregon (DHS) Eating Fish in Oregon (DHS) in waiting in waiting roomsrooms

Rec WCBA and children avoid fish wHgRec WCBA and children avoid fish wHg Enc WCBA to consume low-fat dietEnc WCBA to consume low-fat diet Recycle old Hg thermometers Recycle old Hg thermometers

thermostats amp fluorescent light tubesthermostats amp fluorescent light tubes Have car checked for Hg switches at Have car checked for Hg switches at

participating auto shop (free participating auto shop (free replacement)replacement)

Use digital thermometers amp thermostatsUse digital thermometers amp thermostats

SummarySummary Chronic Diseases are prevalent Toxic Chronic Diseases are prevalent Toxic

exposures are possible exposures are possible preventablepreventable contributorscontributors

Pesticides amp risk of Parkinsonrsquos and Mercury Pesticides amp risk of Parkinsonrsquos and Mercury risks to WCBA are more understood than most risks to WCBA are more understood than most toxins and other chronic diseasestoxins and other chronic diseases

Apparent toxicity at high doses should be a Apparent toxicity at high doses should be a red flag for possible harm from low dose red flag for possible harm from low dose chronic exposureschronic exposures

Since ldquoproofrdquo of harm materializes slowly Since ldquoproofrdquo of harm materializes slowly generations are at risk and may be harmed generations are at risk and may be harmed before adequate regulatory response occursbefore adequate regulatory response occurs

Kaiser amp HCWHh2eKaiser amp HCWHh2e

Clean Diesel Hospital Zones ProjectClean Diesel Hospital Zones Project Healthy Food in Healthcare InitiativeHealthy Food in Healthcare Initiative Green Building PVC and DEHP free Green Building PVC and DEHP free

NICU NICU Environmentally preferable purchasing Environmentally preferable purchasing

policypolicy Making Medicine Mercury Free Award Making Medicine Mercury Free Award h2e Environmental Leadership Award h2e Environmental Leadership Award

20022002

What Can You DoWhat Can You Do

Be aware of environmental toxins amp Be aware of environmental toxins amp their possible links to chronic diseasestheir possible links to chronic diseases

Provide advice amp education on Provide advice amp education on prevention andor minimizing prevention andor minimizing exposures or refer appropriately exposures or refer appropriately

Incorporate environmental questions Incorporate environmental questions into clinical historyinto clinical history

Advocate Advocate wwwenvirohealthactionorgwwwenvirohealthactionorg

Local AdvocacyLocal Advocacy Oregon Environmental CouncilOregon Environmental Council wwwoeconlineorgwwwoeconlineorg Oregon Collaborative on Health amp Oregon Collaborative on Health amp

EnvironmentEnvironment Healthy Environment ForumsHealthy Environment Forums Oregon Center for Environmental HealthOregon Center for Environmental Health wwworegon-healthorgwwworegon-healthorg Healthcare without HarmHealthcare without Harm Hospitals for Healthy Environment (h2e)Hospitals for Healthy Environment (h2e) Oregon PSROregon PSR wwworegonpsrorgwwworegonpsrorg Environmental Health-In Harmrsquos Way Environmental Health-In Harmrsquos Way

Limitations of Current DataLimitations of Current Data

Exposure to chemical mixtures Exposure to chemical mixtures common-research more complexcommon-research more complex

Data available for only minority Data available for only minority single agentssingle agents

Epidemiological amp animal studies Epidemiological amp animal studies often only data availableoften only data available

Result links btw Chronic Diseases amp Result links btw Chronic Diseases amp low dose chronic complex exposures low dose chronic complex exposures hard to ldquoproverdquohard to ldquoproverdquo

PROVEN HARM

PARTIALLY PROVEN

NOT YET RECOGNIZED

FOREVER UNRECOGNIZED

THE TOXIC ICEBERG________________________________________

Oregoniansrsquo HealthOregoniansrsquo Health12 CHEMICALS OF KEY CONCERN12 CHEMICALS OF KEY CONCERN 1048698 1048698 acroleinacrolein 1048698 1048698 benzenebenzene 1048698 1048698 benzo(a)pyrenebenzo(a)pyrene 1048698 1048698 bisphenol-Abisphenol-A 1048698 1048698 brominated flame retardants (BFRs)brominated flame retardants (BFRs) 1048698 1048698 dieseldiesel 1048698 1048698 dioxindioxin 1048698 1048698 formaldehydeformaldehyde 1048698 1048698 leadlead 1048698 1048698 mercurymercury home amp garden pesticideshome amp garden pesticides 1048698 1048698 phthalatesphthalates

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

A 52 yr-old pt co increasing tremor A 52 yr-old pt co increasing tremor On PE the tremor is pill-rolling and On PE the tremor is pill-rolling and resolves with intention +Romberg resolves with intention +Romberg sign unstable tandem gaitsign unstable tandem gait

You make a preliminary diagnosis of You make a preliminary diagnosis of early Parkinsonrsquos diseaseearly Parkinsonrsquos disease

Wife mentions reading about Wife mentions reading about environmental links to PD pt is a environmental links to PD pt is a farmer and has used pesticides for farmer and has used pesticides for years Could this be related to his years Could this be related to his diseasedisease

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

Paraquat rotenone organophosphates Paraquat rotenone organophosphates dieldrin and fungicides maneb amp dieldrin and fungicides maneb amp mancozeb implicatedmancozeb implicated

MPTP a designer heroin-like drug MPTP a designer heroin-like drug causes Parkinsonian syndrome in causes Parkinsonian syndrome in addictsaddicts

Higher incidence in industrialized Higher incidence in industrialized countries greatest risk in rural countries greatest risk in rural areasfarms prolonged pesticide useareasfarms prolonged pesticide use

Case control studies herbicide or Case control studies herbicide or insecticide exposure 3-4x likelyinsecticide exposure 3-4x likely

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

2005 Brown T et al Meta-analysis 2005 Brown T et al Meta-analysis of epidemi-ologic amp toxicologic of epidemi-ologic amp toxicologic studies since 1983 studies since 1983

Verified most of these links noting Verified most of these links noting limitations in study designs limitations in study designs

Conclusion ldquogeneric association btw Conclusion ldquogeneric association btw pesticide exposure amp PD exists but pesticide exposure amp PD exists but is insufficient tohellipconcludehellipa causal is insufficient tohellipconcludehellipa causal relationshiprdquo relationshiprdquo

Pesticides Genes amp PDPesticides Genes amp PD

Dr W Langston of Parkinsonrsquos Dr W Langston of Parkinsonrsquos Institute ldquoAccelerating Research on Institute ldquoAccelerating Research on Genes and Environment in Genes and Environment in Parkinsonrsquos Diseaserdquo (2005)Parkinsonrsquos Diseaserdquo (2005)

Two PD studies underway one in Two PD studies underway one in pesticide applicators other in two pesticide applicators other in two CA counties with known heavy CA counties with known heavy exposureexposure

Other Health Impacts of Other Health Impacts of PesticidesPesticides

ArrhythmiasArrhythmiasAsthmaAsthmaLymphomas Brain tumorsLymphomas Brain tumorsAbnormal sperm countsAbnormal sperm countsBirth defects amp developmental delaysBirth defects amp developmental delaysHyperactivity amp behavioral problemsHyperactivity amp behavioral problemsDecreased endurance amp coordinationDecreased endurance amp coordinationNeurocognitive problemsNeurocognitive problemsPeripheral neuropathiesPeripheral neuropathies

Pesticides a Persistent Pesticides a Persistent ProblemProblem

Major classesMajor classes insecticides fungicides insecticides fungicides herbicides rodenticidesherbicides rodenticides

1997 Market1997 Market US $119 billion World $37 US $119 billion World $37 billionbillion

HistoryHistory synthetic-new to humans amp synthetic-new to humans amp environment since 1940s gt800 licensed environment since 1940s gt800 licensed ldquoactiverdquo ingredientsldquoactiverdquo ingredients

Manufacturers Manufacturers Bayer Aventis other drug Bayer Aventis other drug coco

Inherent toxicityInherent toxicity 140 pesticides considered 140 pesticides considered neurotoxic 37 are used on food ampor feedneurotoxic 37 are used on food ampor feed

Insecticide Sites of Insecticide Sites of ActionAction

Enzymes

Axonal Membranes

Ions (Na+ K+ Ca++ Cl-)

Enzymes

Neurotransmitters

Organochlorines

Pyrethroids

Casarett and Doullrsquos Toxicology The Basic Science of Poisons 5th Edition Ed Klaassen CD

McGraw-Hill New York 1996 P 649

Organophosphorus and

Carbamate Esters

Organophosphate PesticidesOrganophosphate PesticidesOccurrence and distribution in surface amp

ground water of the United States 1992-97

httpgawaterusgsgovpublicationsabstractsofr00-187html

Background Pesticide Background Pesticide Exposures WidespreadExposures Widespread

Reported useReported use 98 of families 80 during 98 of families 80 during pregnancypregnancy

In HumansIn Humans detectable chlorpyrifos detectable chlorpyrifos metabolites in 92 of childrenrsquos 82 of metabolites in 92 of childrenrsquos 82 of adultsrsquo urine samplesadultsrsquo urine samples

In FoodIn Food residues of at least one pesticide on residues of at least one pesticide on 72 fruits amp vegetables72 fruits amp vegetables

In HomesIn Homes 3 to 9 pesticide residues found3 to 9 pesticide residues found

In AirIn Air indoor levels 10-100X higher than indoor levels 10-100X higher than outdooroutdoor

In WaterIn Water gt90 stream samples 50 of gt90 stream samples 50 of wellswells

Sources of PesticidesSources of Pesticides

Household uses lawn amp garden Household uses lawn amp garden sprays exterminators flea collarssprays exterminators flea collars

Household dust (tracking in on shoes)Household dust (tracking in on shoes)

Public schools hospitals parks Public schools hospitals parks childcare facilitieschildcare facilities

Agricultural uses amp workersrsquo clothesAgricultural uses amp workersrsquo clothes

Non-organic foodsNon-organic foods

Breast milkBreast milk

Strategies to Reduces Strategies to Reduces Exposure to Home amp Garden Exposure to Home amp Garden

Pesticides in OregonPesticides in OregonPolicy SolutionsPolicy Solutions OR pesticide use reporting system OR pesticide use reporting system

(1999) finally funded 2005(1999) finally funded 2005 Educate homeowners re nontoxic Educate homeowners re nontoxic

options options Enc pet owners to use flea combs and Enc pet owners to use flea combs and

vacuuming to control fleasvacuuming to control fleas Enc public places to use Integrated Enc public places to use Integrated

Pest Management (IPM) ie Pesticide Pest Management (IPM) ie Pesticide Free ParksFree Parks

What YOU Can Do about What YOU Can Do about PesticidesPesticides

Advise PatientsAdvise Patients Regularly dustRegularly dust Use Integrated Pest Management Use Integrated Pest Management Cleanremove shoes outsideCleanremove shoes outside Keep contaminated clothes separateKeep contaminated clothes separate Buy sustainably grown foodBuy sustainably grown food Store food in secure nontoxic Store food in secure nontoxic

containerscontainers

Mercury amp Women of Mercury amp Women of Childbearing AgeChildbearing Age

A 32 yo G0P0 woman of A 32 yo G0P0 woman of childbearing age (WCBA) childbearing age (WCBA) presents for annual PE presents for annual PE

PMH negativePMH negative

Social hx husband is Social hx husband is recreational fisherman recreational fisherman

Contemplating pregnancy Contemplating pregnancy

Should she avoid fish Should she avoid fish because of mercury risks because of mercury risks to the fetusto the fetus

Mercury amp WCBAMercury amp WCBA

gt10gt10 of WCBA exceed safe limit of of WCBA exceed safe limit of 1ugkgday1ugkgday

5050 of women of women who eat fishwho eat fish exceed exceed limitlimit

5757 of WCBA have Hg levels of WCBA have Hg levels concerning for adverse effects concerning for adverse effects (CDC (CDC Natrsquol Report 0705Natrsquol Report 0705))

Higher risk Higher risk 300 000 childrenyear 300 000 childrenyear subsistence fishers immigrants subsistence fishers immigrants Native AmericansNative Americans

Mercury amp WCBAMercury amp WCBA

Hg enters tissues variable excretionHg enters tissues variable excretion Breast Milk PCBs DDT amp other Breast Milk PCBs DDT amp other

pesticides dioxins dibenzofurans pesticides dioxins dibenzofurans toxic flame retardants amp heavy toxic flame retardants amp heavy metals (Pb amp Hg) metals (Pb amp Hg)

No bio-accumulation in milk but No bio-accumulation in milk but levels in fish-eaters may exceed levels in fish-eaters may exceed unexposed women by 100x unexposed women by 100x

Scientific evidence indicates Scientific evidence indicates advantages of breast-feeding advantages of breast-feeding outweigh riskshellipoutweigh riskshellip

Neuro Effects of MercuryNeuro Effects of Mercury

Cerebral palsyCerebral palsy MRDDMRDD disequilibrium ataxiadisequilibrium ataxia hearing lossdeafnesshearing lossdeafness visual visual

impairmentblindnessimpairmentblindness peripheral neuropathyperipheral neuropathy parasthesiasparasthesias tremors seizures tremors seizures abnl reflexes amp muscle toneabnl reflexes amp muscle tone Psychiatric disturbances Psychiatric disturbances

Mercury a Persistent Mercury a Persistent ProblemProblem

PoisoningsPoisonings Minamata 1950s amp Iraq Minamata 1950s amp Iraq 19711971

Nationally ~Nationally ~160 tons of Hg annually160 tons of Hg annually In OregonIn Oregon ~ ~4500 lbs annually4500 lbs annually Lack of regulationLack of regulation In OR 10 facilities In OR 10 facilities

report Hg release-none has a permit or is report Hg release-none has a permit or is required to monitor emissions by staterequired to monitor emissions by state

Fish AdvisoriesFish Advisories in 2004 45 states had in 2004 45 states had gt2000 warnings Oregon lists advisories gt2000 warnings Oregon lists advisories for 12 water bodies inc Willamette for 12 water bodies inc Willamette

Atmospheric HgAtmospheric Hg

The Mercury CycleThe Mercury Cycle

MercuryMercuryDeclining Threshold of Declining Threshold of

HarmHarm

2000199019801970001

01

1

10

100

YEAR

Level associated with harmful effectRegulatory standard (maximum safe exposure or high end exposure from allowed fish contamination)

FDA WHO

EPA

ATSDR

DA

ILY

IN

TA

KE

(mic

rogr

ams

kg

day

Hg)

Sources of MercurySources of MercuryIndustrial emissions Industrial emissions

coal fired plantscoal fired plantsMunicipal amp medical Municipal amp medical

waste incineratorswaste incineratorsAbandoned Hg amp gold Abandoned Hg amp gold

minesminesNatural off-gassing Natural off-gassing Dental amalgamsDental amalgamsBioaccumulation in Bioaccumulation in

foods esp fishfoods esp fishOld thermometers BP Old thermometers BP

cuffs amp auto cuffs amp auto switchesswitches

Strategies to Reduce Strategies to Reduce Mercury Pollution in Mercury Pollution in

OregonOregonPolicy SolutionsPolicy Solutions Mercury Solutions Act of 2001Mercury Solutions Act of 2001 Ensure safe collection amp recyclingEnsure safe collection amp recycling Clean up abandoned mines and Clean up abandoned mines and

SuperfundsSuperfunds Reduce Hg emissions from health Reduce Hg emissions from health

care facilitiescare facilities Inc Hg in applicable DEQ air amp Inc Hg in applicable DEQ air amp

water permitswater permits Coal burning power plant Boardman Coal burning power plant Boardman

OR OR Implement OR Executive OrderImplement OR Executive Order

What YOU Can Do about What YOU Can Do about MercuryMercury

Advise PatientsAdvise Patients Provide Provide An Expectant Motherrsquos Guide to An Expectant Motherrsquos Guide to

Eating Fish in Oregon (DHS) Eating Fish in Oregon (DHS) in waiting in waiting roomsrooms

Rec WCBA and children avoid fish wHgRec WCBA and children avoid fish wHg Enc WCBA to consume low-fat dietEnc WCBA to consume low-fat diet Recycle old Hg thermometers Recycle old Hg thermometers

thermostats amp fluorescent light tubesthermostats amp fluorescent light tubes Have car checked for Hg switches at Have car checked for Hg switches at

participating auto shop (free participating auto shop (free replacement)replacement)

Use digital thermometers amp thermostatsUse digital thermometers amp thermostats

SummarySummary Chronic Diseases are prevalent Toxic Chronic Diseases are prevalent Toxic

exposures are possible exposures are possible preventablepreventable contributorscontributors

Pesticides amp risk of Parkinsonrsquos and Mercury Pesticides amp risk of Parkinsonrsquos and Mercury risks to WCBA are more understood than most risks to WCBA are more understood than most toxins and other chronic diseasestoxins and other chronic diseases

Apparent toxicity at high doses should be a Apparent toxicity at high doses should be a red flag for possible harm from low dose red flag for possible harm from low dose chronic exposureschronic exposures

Since ldquoproofrdquo of harm materializes slowly Since ldquoproofrdquo of harm materializes slowly generations are at risk and may be harmed generations are at risk and may be harmed before adequate regulatory response occursbefore adequate regulatory response occurs

Kaiser amp HCWHh2eKaiser amp HCWHh2e

Clean Diesel Hospital Zones ProjectClean Diesel Hospital Zones Project Healthy Food in Healthcare InitiativeHealthy Food in Healthcare Initiative Green Building PVC and DEHP free Green Building PVC and DEHP free

NICU NICU Environmentally preferable purchasing Environmentally preferable purchasing

policypolicy Making Medicine Mercury Free Award Making Medicine Mercury Free Award h2e Environmental Leadership Award h2e Environmental Leadership Award

20022002

What Can You DoWhat Can You Do

Be aware of environmental toxins amp Be aware of environmental toxins amp their possible links to chronic diseasestheir possible links to chronic diseases

Provide advice amp education on Provide advice amp education on prevention andor minimizing prevention andor minimizing exposures or refer appropriately exposures or refer appropriately

Incorporate environmental questions Incorporate environmental questions into clinical historyinto clinical history

Advocate Advocate wwwenvirohealthactionorgwwwenvirohealthactionorg

Local AdvocacyLocal Advocacy Oregon Environmental CouncilOregon Environmental Council wwwoeconlineorgwwwoeconlineorg Oregon Collaborative on Health amp Oregon Collaborative on Health amp

EnvironmentEnvironment Healthy Environment ForumsHealthy Environment Forums Oregon Center for Environmental HealthOregon Center for Environmental Health wwworegon-healthorgwwworegon-healthorg Healthcare without HarmHealthcare without Harm Hospitals for Healthy Environment (h2e)Hospitals for Healthy Environment (h2e) Oregon PSROregon PSR wwworegonpsrorgwwworegonpsrorg Environmental Health-In Harmrsquos Way Environmental Health-In Harmrsquos Way

PROVEN HARM

PARTIALLY PROVEN

NOT YET RECOGNIZED

FOREVER UNRECOGNIZED

THE TOXIC ICEBERG________________________________________

Oregoniansrsquo HealthOregoniansrsquo Health12 CHEMICALS OF KEY CONCERN12 CHEMICALS OF KEY CONCERN 1048698 1048698 acroleinacrolein 1048698 1048698 benzenebenzene 1048698 1048698 benzo(a)pyrenebenzo(a)pyrene 1048698 1048698 bisphenol-Abisphenol-A 1048698 1048698 brominated flame retardants (BFRs)brominated flame retardants (BFRs) 1048698 1048698 dieseldiesel 1048698 1048698 dioxindioxin 1048698 1048698 formaldehydeformaldehyde 1048698 1048698 leadlead 1048698 1048698 mercurymercury home amp garden pesticideshome amp garden pesticides 1048698 1048698 phthalatesphthalates

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

A 52 yr-old pt co increasing tremor A 52 yr-old pt co increasing tremor On PE the tremor is pill-rolling and On PE the tremor is pill-rolling and resolves with intention +Romberg resolves with intention +Romberg sign unstable tandem gaitsign unstable tandem gait

You make a preliminary diagnosis of You make a preliminary diagnosis of early Parkinsonrsquos diseaseearly Parkinsonrsquos disease

Wife mentions reading about Wife mentions reading about environmental links to PD pt is a environmental links to PD pt is a farmer and has used pesticides for farmer and has used pesticides for years Could this be related to his years Could this be related to his diseasedisease

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

Paraquat rotenone organophosphates Paraquat rotenone organophosphates dieldrin and fungicides maneb amp dieldrin and fungicides maneb amp mancozeb implicatedmancozeb implicated

MPTP a designer heroin-like drug MPTP a designer heroin-like drug causes Parkinsonian syndrome in causes Parkinsonian syndrome in addictsaddicts

Higher incidence in industrialized Higher incidence in industrialized countries greatest risk in rural countries greatest risk in rural areasfarms prolonged pesticide useareasfarms prolonged pesticide use

Case control studies herbicide or Case control studies herbicide or insecticide exposure 3-4x likelyinsecticide exposure 3-4x likely

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

2005 Brown T et al Meta-analysis 2005 Brown T et al Meta-analysis of epidemi-ologic amp toxicologic of epidemi-ologic amp toxicologic studies since 1983 studies since 1983

Verified most of these links noting Verified most of these links noting limitations in study designs limitations in study designs

Conclusion ldquogeneric association btw Conclusion ldquogeneric association btw pesticide exposure amp PD exists but pesticide exposure amp PD exists but is insufficient tohellipconcludehellipa causal is insufficient tohellipconcludehellipa causal relationshiprdquo relationshiprdquo

Pesticides Genes amp PDPesticides Genes amp PD

Dr W Langston of Parkinsonrsquos Dr W Langston of Parkinsonrsquos Institute ldquoAccelerating Research on Institute ldquoAccelerating Research on Genes and Environment in Genes and Environment in Parkinsonrsquos Diseaserdquo (2005)Parkinsonrsquos Diseaserdquo (2005)

Two PD studies underway one in Two PD studies underway one in pesticide applicators other in two pesticide applicators other in two CA counties with known heavy CA counties with known heavy exposureexposure

Other Health Impacts of Other Health Impacts of PesticidesPesticides

ArrhythmiasArrhythmiasAsthmaAsthmaLymphomas Brain tumorsLymphomas Brain tumorsAbnormal sperm countsAbnormal sperm countsBirth defects amp developmental delaysBirth defects amp developmental delaysHyperactivity amp behavioral problemsHyperactivity amp behavioral problemsDecreased endurance amp coordinationDecreased endurance amp coordinationNeurocognitive problemsNeurocognitive problemsPeripheral neuropathiesPeripheral neuropathies

Pesticides a Persistent Pesticides a Persistent ProblemProblem

Major classesMajor classes insecticides fungicides insecticides fungicides herbicides rodenticidesherbicides rodenticides

1997 Market1997 Market US $119 billion World $37 US $119 billion World $37 billionbillion

HistoryHistory synthetic-new to humans amp synthetic-new to humans amp environment since 1940s gt800 licensed environment since 1940s gt800 licensed ldquoactiverdquo ingredientsldquoactiverdquo ingredients

Manufacturers Manufacturers Bayer Aventis other drug Bayer Aventis other drug coco

Inherent toxicityInherent toxicity 140 pesticides considered 140 pesticides considered neurotoxic 37 are used on food ampor feedneurotoxic 37 are used on food ampor feed

Insecticide Sites of Insecticide Sites of ActionAction

Enzymes

Axonal Membranes

Ions (Na+ K+ Ca++ Cl-)

Enzymes

Neurotransmitters

Organochlorines

Pyrethroids

Casarett and Doullrsquos Toxicology The Basic Science of Poisons 5th Edition Ed Klaassen CD

McGraw-Hill New York 1996 P 649

Organophosphorus and

Carbamate Esters

Organophosphate PesticidesOrganophosphate PesticidesOccurrence and distribution in surface amp

ground water of the United States 1992-97

httpgawaterusgsgovpublicationsabstractsofr00-187html

Background Pesticide Background Pesticide Exposures WidespreadExposures Widespread

Reported useReported use 98 of families 80 during 98 of families 80 during pregnancypregnancy

In HumansIn Humans detectable chlorpyrifos detectable chlorpyrifos metabolites in 92 of childrenrsquos 82 of metabolites in 92 of childrenrsquos 82 of adultsrsquo urine samplesadultsrsquo urine samples

In FoodIn Food residues of at least one pesticide on residues of at least one pesticide on 72 fruits amp vegetables72 fruits amp vegetables

In HomesIn Homes 3 to 9 pesticide residues found3 to 9 pesticide residues found

In AirIn Air indoor levels 10-100X higher than indoor levels 10-100X higher than outdooroutdoor

In WaterIn Water gt90 stream samples 50 of gt90 stream samples 50 of wellswells

Sources of PesticidesSources of Pesticides

Household uses lawn amp garden Household uses lawn amp garden sprays exterminators flea collarssprays exterminators flea collars

Household dust (tracking in on shoes)Household dust (tracking in on shoes)

Public schools hospitals parks Public schools hospitals parks childcare facilitieschildcare facilities

Agricultural uses amp workersrsquo clothesAgricultural uses amp workersrsquo clothes

Non-organic foodsNon-organic foods

Breast milkBreast milk

Strategies to Reduces Strategies to Reduces Exposure to Home amp Garden Exposure to Home amp Garden

Pesticides in OregonPesticides in OregonPolicy SolutionsPolicy Solutions OR pesticide use reporting system OR pesticide use reporting system

(1999) finally funded 2005(1999) finally funded 2005 Educate homeowners re nontoxic Educate homeowners re nontoxic

options options Enc pet owners to use flea combs and Enc pet owners to use flea combs and

vacuuming to control fleasvacuuming to control fleas Enc public places to use Integrated Enc public places to use Integrated

Pest Management (IPM) ie Pesticide Pest Management (IPM) ie Pesticide Free ParksFree Parks

What YOU Can Do about What YOU Can Do about PesticidesPesticides

Advise PatientsAdvise Patients Regularly dustRegularly dust Use Integrated Pest Management Use Integrated Pest Management Cleanremove shoes outsideCleanremove shoes outside Keep contaminated clothes separateKeep contaminated clothes separate Buy sustainably grown foodBuy sustainably grown food Store food in secure nontoxic Store food in secure nontoxic

containerscontainers

Mercury amp Women of Mercury amp Women of Childbearing AgeChildbearing Age

A 32 yo G0P0 woman of A 32 yo G0P0 woman of childbearing age (WCBA) childbearing age (WCBA) presents for annual PE presents for annual PE

PMH negativePMH negative

Social hx husband is Social hx husband is recreational fisherman recreational fisherman

Contemplating pregnancy Contemplating pregnancy

Should she avoid fish Should she avoid fish because of mercury risks because of mercury risks to the fetusto the fetus

Mercury amp WCBAMercury amp WCBA

gt10gt10 of WCBA exceed safe limit of of WCBA exceed safe limit of 1ugkgday1ugkgday

5050 of women of women who eat fishwho eat fish exceed exceed limitlimit

5757 of WCBA have Hg levels of WCBA have Hg levels concerning for adverse effects concerning for adverse effects (CDC (CDC Natrsquol Report 0705Natrsquol Report 0705))

Higher risk Higher risk 300 000 childrenyear 300 000 childrenyear subsistence fishers immigrants subsistence fishers immigrants Native AmericansNative Americans

Mercury amp WCBAMercury amp WCBA

Hg enters tissues variable excretionHg enters tissues variable excretion Breast Milk PCBs DDT amp other Breast Milk PCBs DDT amp other

pesticides dioxins dibenzofurans pesticides dioxins dibenzofurans toxic flame retardants amp heavy toxic flame retardants amp heavy metals (Pb amp Hg) metals (Pb amp Hg)

No bio-accumulation in milk but No bio-accumulation in milk but levels in fish-eaters may exceed levels in fish-eaters may exceed unexposed women by 100x unexposed women by 100x

Scientific evidence indicates Scientific evidence indicates advantages of breast-feeding advantages of breast-feeding outweigh riskshellipoutweigh riskshellip

Neuro Effects of MercuryNeuro Effects of Mercury

Cerebral palsyCerebral palsy MRDDMRDD disequilibrium ataxiadisequilibrium ataxia hearing lossdeafnesshearing lossdeafness visual visual

impairmentblindnessimpairmentblindness peripheral neuropathyperipheral neuropathy parasthesiasparasthesias tremors seizures tremors seizures abnl reflexes amp muscle toneabnl reflexes amp muscle tone Psychiatric disturbances Psychiatric disturbances

Mercury a Persistent Mercury a Persistent ProblemProblem

PoisoningsPoisonings Minamata 1950s amp Iraq Minamata 1950s amp Iraq 19711971

Nationally ~Nationally ~160 tons of Hg annually160 tons of Hg annually In OregonIn Oregon ~ ~4500 lbs annually4500 lbs annually Lack of regulationLack of regulation In OR 10 facilities In OR 10 facilities

report Hg release-none has a permit or is report Hg release-none has a permit or is required to monitor emissions by staterequired to monitor emissions by state

Fish AdvisoriesFish Advisories in 2004 45 states had in 2004 45 states had gt2000 warnings Oregon lists advisories gt2000 warnings Oregon lists advisories for 12 water bodies inc Willamette for 12 water bodies inc Willamette

Atmospheric HgAtmospheric Hg

The Mercury CycleThe Mercury Cycle

MercuryMercuryDeclining Threshold of Declining Threshold of

HarmHarm

2000199019801970001

01

1

10

100

YEAR

Level associated with harmful effectRegulatory standard (maximum safe exposure or high end exposure from allowed fish contamination)

FDA WHO

EPA

ATSDR

DA

ILY

IN

TA

KE

(mic

rogr

ams

kg

day

Hg)

Sources of MercurySources of MercuryIndustrial emissions Industrial emissions

coal fired plantscoal fired plantsMunicipal amp medical Municipal amp medical

waste incineratorswaste incineratorsAbandoned Hg amp gold Abandoned Hg amp gold

minesminesNatural off-gassing Natural off-gassing Dental amalgamsDental amalgamsBioaccumulation in Bioaccumulation in

foods esp fishfoods esp fishOld thermometers BP Old thermometers BP

cuffs amp auto cuffs amp auto switchesswitches

Strategies to Reduce Strategies to Reduce Mercury Pollution in Mercury Pollution in

OregonOregonPolicy SolutionsPolicy Solutions Mercury Solutions Act of 2001Mercury Solutions Act of 2001 Ensure safe collection amp recyclingEnsure safe collection amp recycling Clean up abandoned mines and Clean up abandoned mines and

SuperfundsSuperfunds Reduce Hg emissions from health Reduce Hg emissions from health

care facilitiescare facilities Inc Hg in applicable DEQ air amp Inc Hg in applicable DEQ air amp

water permitswater permits Coal burning power plant Boardman Coal burning power plant Boardman

OR OR Implement OR Executive OrderImplement OR Executive Order

What YOU Can Do about What YOU Can Do about MercuryMercury

Advise PatientsAdvise Patients Provide Provide An Expectant Motherrsquos Guide to An Expectant Motherrsquos Guide to

Eating Fish in Oregon (DHS) Eating Fish in Oregon (DHS) in waiting in waiting roomsrooms

Rec WCBA and children avoid fish wHgRec WCBA and children avoid fish wHg Enc WCBA to consume low-fat dietEnc WCBA to consume low-fat diet Recycle old Hg thermometers Recycle old Hg thermometers

thermostats amp fluorescent light tubesthermostats amp fluorescent light tubes Have car checked for Hg switches at Have car checked for Hg switches at

participating auto shop (free participating auto shop (free replacement)replacement)

Use digital thermometers amp thermostatsUse digital thermometers amp thermostats

SummarySummary Chronic Diseases are prevalent Toxic Chronic Diseases are prevalent Toxic

exposures are possible exposures are possible preventablepreventable contributorscontributors

Pesticides amp risk of Parkinsonrsquos and Mercury Pesticides amp risk of Parkinsonrsquos and Mercury risks to WCBA are more understood than most risks to WCBA are more understood than most toxins and other chronic diseasestoxins and other chronic diseases

Apparent toxicity at high doses should be a Apparent toxicity at high doses should be a red flag for possible harm from low dose red flag for possible harm from low dose chronic exposureschronic exposures

Since ldquoproofrdquo of harm materializes slowly Since ldquoproofrdquo of harm materializes slowly generations are at risk and may be harmed generations are at risk and may be harmed before adequate regulatory response occursbefore adequate regulatory response occurs

Kaiser amp HCWHh2eKaiser amp HCWHh2e

Clean Diesel Hospital Zones ProjectClean Diesel Hospital Zones Project Healthy Food in Healthcare InitiativeHealthy Food in Healthcare Initiative Green Building PVC and DEHP free Green Building PVC and DEHP free

NICU NICU Environmentally preferable purchasing Environmentally preferable purchasing

policypolicy Making Medicine Mercury Free Award Making Medicine Mercury Free Award h2e Environmental Leadership Award h2e Environmental Leadership Award

20022002

What Can You DoWhat Can You Do

Be aware of environmental toxins amp Be aware of environmental toxins amp their possible links to chronic diseasestheir possible links to chronic diseases

Provide advice amp education on Provide advice amp education on prevention andor minimizing prevention andor minimizing exposures or refer appropriately exposures or refer appropriately

Incorporate environmental questions Incorporate environmental questions into clinical historyinto clinical history

Advocate Advocate wwwenvirohealthactionorgwwwenvirohealthactionorg

Local AdvocacyLocal Advocacy Oregon Environmental CouncilOregon Environmental Council wwwoeconlineorgwwwoeconlineorg Oregon Collaborative on Health amp Oregon Collaborative on Health amp

EnvironmentEnvironment Healthy Environment ForumsHealthy Environment Forums Oregon Center for Environmental HealthOregon Center for Environmental Health wwworegon-healthorgwwworegon-healthorg Healthcare without HarmHealthcare without Harm Hospitals for Healthy Environment (h2e)Hospitals for Healthy Environment (h2e) Oregon PSROregon PSR wwworegonpsrorgwwworegonpsrorg Environmental Health-In Harmrsquos Way Environmental Health-In Harmrsquos Way

Oregoniansrsquo HealthOregoniansrsquo Health12 CHEMICALS OF KEY CONCERN12 CHEMICALS OF KEY CONCERN 1048698 1048698 acroleinacrolein 1048698 1048698 benzenebenzene 1048698 1048698 benzo(a)pyrenebenzo(a)pyrene 1048698 1048698 bisphenol-Abisphenol-A 1048698 1048698 brominated flame retardants (BFRs)brominated flame retardants (BFRs) 1048698 1048698 dieseldiesel 1048698 1048698 dioxindioxin 1048698 1048698 formaldehydeformaldehyde 1048698 1048698 leadlead 1048698 1048698 mercurymercury home amp garden pesticideshome amp garden pesticides 1048698 1048698 phthalatesphthalates

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

A 52 yr-old pt co increasing tremor A 52 yr-old pt co increasing tremor On PE the tremor is pill-rolling and On PE the tremor is pill-rolling and resolves with intention +Romberg resolves with intention +Romberg sign unstable tandem gaitsign unstable tandem gait

You make a preliminary diagnosis of You make a preliminary diagnosis of early Parkinsonrsquos diseaseearly Parkinsonrsquos disease

Wife mentions reading about Wife mentions reading about environmental links to PD pt is a environmental links to PD pt is a farmer and has used pesticides for farmer and has used pesticides for years Could this be related to his years Could this be related to his diseasedisease

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

Paraquat rotenone organophosphates Paraquat rotenone organophosphates dieldrin and fungicides maneb amp dieldrin and fungicides maneb amp mancozeb implicatedmancozeb implicated

MPTP a designer heroin-like drug MPTP a designer heroin-like drug causes Parkinsonian syndrome in causes Parkinsonian syndrome in addictsaddicts

Higher incidence in industrialized Higher incidence in industrialized countries greatest risk in rural countries greatest risk in rural areasfarms prolonged pesticide useareasfarms prolonged pesticide use

Case control studies herbicide or Case control studies herbicide or insecticide exposure 3-4x likelyinsecticide exposure 3-4x likely

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

2005 Brown T et al Meta-analysis 2005 Brown T et al Meta-analysis of epidemi-ologic amp toxicologic of epidemi-ologic amp toxicologic studies since 1983 studies since 1983

Verified most of these links noting Verified most of these links noting limitations in study designs limitations in study designs

Conclusion ldquogeneric association btw Conclusion ldquogeneric association btw pesticide exposure amp PD exists but pesticide exposure amp PD exists but is insufficient tohellipconcludehellipa causal is insufficient tohellipconcludehellipa causal relationshiprdquo relationshiprdquo

Pesticides Genes amp PDPesticides Genes amp PD

Dr W Langston of Parkinsonrsquos Dr W Langston of Parkinsonrsquos Institute ldquoAccelerating Research on Institute ldquoAccelerating Research on Genes and Environment in Genes and Environment in Parkinsonrsquos Diseaserdquo (2005)Parkinsonrsquos Diseaserdquo (2005)

Two PD studies underway one in Two PD studies underway one in pesticide applicators other in two pesticide applicators other in two CA counties with known heavy CA counties with known heavy exposureexposure

Other Health Impacts of Other Health Impacts of PesticidesPesticides

ArrhythmiasArrhythmiasAsthmaAsthmaLymphomas Brain tumorsLymphomas Brain tumorsAbnormal sperm countsAbnormal sperm countsBirth defects amp developmental delaysBirth defects amp developmental delaysHyperactivity amp behavioral problemsHyperactivity amp behavioral problemsDecreased endurance amp coordinationDecreased endurance amp coordinationNeurocognitive problemsNeurocognitive problemsPeripheral neuropathiesPeripheral neuropathies

Pesticides a Persistent Pesticides a Persistent ProblemProblem

Major classesMajor classes insecticides fungicides insecticides fungicides herbicides rodenticidesherbicides rodenticides

1997 Market1997 Market US $119 billion World $37 US $119 billion World $37 billionbillion

HistoryHistory synthetic-new to humans amp synthetic-new to humans amp environment since 1940s gt800 licensed environment since 1940s gt800 licensed ldquoactiverdquo ingredientsldquoactiverdquo ingredients

Manufacturers Manufacturers Bayer Aventis other drug Bayer Aventis other drug coco

Inherent toxicityInherent toxicity 140 pesticides considered 140 pesticides considered neurotoxic 37 are used on food ampor feedneurotoxic 37 are used on food ampor feed

Insecticide Sites of Insecticide Sites of ActionAction

Enzymes

Axonal Membranes

Ions (Na+ K+ Ca++ Cl-)

Enzymes

Neurotransmitters

Organochlorines

Pyrethroids

Casarett and Doullrsquos Toxicology The Basic Science of Poisons 5th Edition Ed Klaassen CD

McGraw-Hill New York 1996 P 649

Organophosphorus and

Carbamate Esters

Organophosphate PesticidesOrganophosphate PesticidesOccurrence and distribution in surface amp

ground water of the United States 1992-97

httpgawaterusgsgovpublicationsabstractsofr00-187html

Background Pesticide Background Pesticide Exposures WidespreadExposures Widespread

Reported useReported use 98 of families 80 during 98 of families 80 during pregnancypregnancy

In HumansIn Humans detectable chlorpyrifos detectable chlorpyrifos metabolites in 92 of childrenrsquos 82 of metabolites in 92 of childrenrsquos 82 of adultsrsquo urine samplesadultsrsquo urine samples

In FoodIn Food residues of at least one pesticide on residues of at least one pesticide on 72 fruits amp vegetables72 fruits amp vegetables

In HomesIn Homes 3 to 9 pesticide residues found3 to 9 pesticide residues found

In AirIn Air indoor levels 10-100X higher than indoor levels 10-100X higher than outdooroutdoor

In WaterIn Water gt90 stream samples 50 of gt90 stream samples 50 of wellswells

Sources of PesticidesSources of Pesticides

Household uses lawn amp garden Household uses lawn amp garden sprays exterminators flea collarssprays exterminators flea collars

Household dust (tracking in on shoes)Household dust (tracking in on shoes)

Public schools hospitals parks Public schools hospitals parks childcare facilitieschildcare facilities

Agricultural uses amp workersrsquo clothesAgricultural uses amp workersrsquo clothes

Non-organic foodsNon-organic foods

Breast milkBreast milk

Strategies to Reduces Strategies to Reduces Exposure to Home amp Garden Exposure to Home amp Garden

Pesticides in OregonPesticides in OregonPolicy SolutionsPolicy Solutions OR pesticide use reporting system OR pesticide use reporting system

(1999) finally funded 2005(1999) finally funded 2005 Educate homeowners re nontoxic Educate homeowners re nontoxic

options options Enc pet owners to use flea combs and Enc pet owners to use flea combs and

vacuuming to control fleasvacuuming to control fleas Enc public places to use Integrated Enc public places to use Integrated

Pest Management (IPM) ie Pesticide Pest Management (IPM) ie Pesticide Free ParksFree Parks

What YOU Can Do about What YOU Can Do about PesticidesPesticides

Advise PatientsAdvise Patients Regularly dustRegularly dust Use Integrated Pest Management Use Integrated Pest Management Cleanremove shoes outsideCleanremove shoes outside Keep contaminated clothes separateKeep contaminated clothes separate Buy sustainably grown foodBuy sustainably grown food Store food in secure nontoxic Store food in secure nontoxic

containerscontainers

Mercury amp Women of Mercury amp Women of Childbearing AgeChildbearing Age

A 32 yo G0P0 woman of A 32 yo G0P0 woman of childbearing age (WCBA) childbearing age (WCBA) presents for annual PE presents for annual PE

PMH negativePMH negative

Social hx husband is Social hx husband is recreational fisherman recreational fisherman

Contemplating pregnancy Contemplating pregnancy

Should she avoid fish Should she avoid fish because of mercury risks because of mercury risks to the fetusto the fetus

Mercury amp WCBAMercury amp WCBA

gt10gt10 of WCBA exceed safe limit of of WCBA exceed safe limit of 1ugkgday1ugkgday

5050 of women of women who eat fishwho eat fish exceed exceed limitlimit

5757 of WCBA have Hg levels of WCBA have Hg levels concerning for adverse effects concerning for adverse effects (CDC (CDC Natrsquol Report 0705Natrsquol Report 0705))

Higher risk Higher risk 300 000 childrenyear 300 000 childrenyear subsistence fishers immigrants subsistence fishers immigrants Native AmericansNative Americans

Mercury amp WCBAMercury amp WCBA

Hg enters tissues variable excretionHg enters tissues variable excretion Breast Milk PCBs DDT amp other Breast Milk PCBs DDT amp other

pesticides dioxins dibenzofurans pesticides dioxins dibenzofurans toxic flame retardants amp heavy toxic flame retardants amp heavy metals (Pb amp Hg) metals (Pb amp Hg)

No bio-accumulation in milk but No bio-accumulation in milk but levels in fish-eaters may exceed levels in fish-eaters may exceed unexposed women by 100x unexposed women by 100x

Scientific evidence indicates Scientific evidence indicates advantages of breast-feeding advantages of breast-feeding outweigh riskshellipoutweigh riskshellip

Neuro Effects of MercuryNeuro Effects of Mercury

Cerebral palsyCerebral palsy MRDDMRDD disequilibrium ataxiadisequilibrium ataxia hearing lossdeafnesshearing lossdeafness visual visual

impairmentblindnessimpairmentblindness peripheral neuropathyperipheral neuropathy parasthesiasparasthesias tremors seizures tremors seizures abnl reflexes amp muscle toneabnl reflexes amp muscle tone Psychiatric disturbances Psychiatric disturbances

Mercury a Persistent Mercury a Persistent ProblemProblem

PoisoningsPoisonings Minamata 1950s amp Iraq Minamata 1950s amp Iraq 19711971

Nationally ~Nationally ~160 tons of Hg annually160 tons of Hg annually In OregonIn Oregon ~ ~4500 lbs annually4500 lbs annually Lack of regulationLack of regulation In OR 10 facilities In OR 10 facilities

report Hg release-none has a permit or is report Hg release-none has a permit or is required to monitor emissions by staterequired to monitor emissions by state

Fish AdvisoriesFish Advisories in 2004 45 states had in 2004 45 states had gt2000 warnings Oregon lists advisories gt2000 warnings Oregon lists advisories for 12 water bodies inc Willamette for 12 water bodies inc Willamette

Atmospheric HgAtmospheric Hg

The Mercury CycleThe Mercury Cycle

MercuryMercuryDeclining Threshold of Declining Threshold of

HarmHarm

2000199019801970001

01

1

10

100

YEAR

Level associated with harmful effectRegulatory standard (maximum safe exposure or high end exposure from allowed fish contamination)

FDA WHO

EPA

ATSDR

DA

ILY

IN

TA

KE

(mic

rogr

ams

kg

day

Hg)

Sources of MercurySources of MercuryIndustrial emissions Industrial emissions

coal fired plantscoal fired plantsMunicipal amp medical Municipal amp medical

waste incineratorswaste incineratorsAbandoned Hg amp gold Abandoned Hg amp gold

minesminesNatural off-gassing Natural off-gassing Dental amalgamsDental amalgamsBioaccumulation in Bioaccumulation in

foods esp fishfoods esp fishOld thermometers BP Old thermometers BP

cuffs amp auto cuffs amp auto switchesswitches

Strategies to Reduce Strategies to Reduce Mercury Pollution in Mercury Pollution in

OregonOregonPolicy SolutionsPolicy Solutions Mercury Solutions Act of 2001Mercury Solutions Act of 2001 Ensure safe collection amp recyclingEnsure safe collection amp recycling Clean up abandoned mines and Clean up abandoned mines and

SuperfundsSuperfunds Reduce Hg emissions from health Reduce Hg emissions from health

care facilitiescare facilities Inc Hg in applicable DEQ air amp Inc Hg in applicable DEQ air amp

water permitswater permits Coal burning power plant Boardman Coal burning power plant Boardman

OR OR Implement OR Executive OrderImplement OR Executive Order

What YOU Can Do about What YOU Can Do about MercuryMercury

Advise PatientsAdvise Patients Provide Provide An Expectant Motherrsquos Guide to An Expectant Motherrsquos Guide to

Eating Fish in Oregon (DHS) Eating Fish in Oregon (DHS) in waiting in waiting roomsrooms

Rec WCBA and children avoid fish wHgRec WCBA and children avoid fish wHg Enc WCBA to consume low-fat dietEnc WCBA to consume low-fat diet Recycle old Hg thermometers Recycle old Hg thermometers

thermostats amp fluorescent light tubesthermostats amp fluorescent light tubes Have car checked for Hg switches at Have car checked for Hg switches at

participating auto shop (free participating auto shop (free replacement)replacement)

Use digital thermometers amp thermostatsUse digital thermometers amp thermostats

SummarySummary Chronic Diseases are prevalent Toxic Chronic Diseases are prevalent Toxic

exposures are possible exposures are possible preventablepreventable contributorscontributors

Pesticides amp risk of Parkinsonrsquos and Mercury Pesticides amp risk of Parkinsonrsquos and Mercury risks to WCBA are more understood than most risks to WCBA are more understood than most toxins and other chronic diseasestoxins and other chronic diseases

Apparent toxicity at high doses should be a Apparent toxicity at high doses should be a red flag for possible harm from low dose red flag for possible harm from low dose chronic exposureschronic exposures

Since ldquoproofrdquo of harm materializes slowly Since ldquoproofrdquo of harm materializes slowly generations are at risk and may be harmed generations are at risk and may be harmed before adequate regulatory response occursbefore adequate regulatory response occurs

Kaiser amp HCWHh2eKaiser amp HCWHh2e

Clean Diesel Hospital Zones ProjectClean Diesel Hospital Zones Project Healthy Food in Healthcare InitiativeHealthy Food in Healthcare Initiative Green Building PVC and DEHP free Green Building PVC and DEHP free

NICU NICU Environmentally preferable purchasing Environmentally preferable purchasing

policypolicy Making Medicine Mercury Free Award Making Medicine Mercury Free Award h2e Environmental Leadership Award h2e Environmental Leadership Award

20022002

What Can You DoWhat Can You Do

Be aware of environmental toxins amp Be aware of environmental toxins amp their possible links to chronic diseasestheir possible links to chronic diseases

Provide advice amp education on Provide advice amp education on prevention andor minimizing prevention andor minimizing exposures or refer appropriately exposures or refer appropriately

Incorporate environmental questions Incorporate environmental questions into clinical historyinto clinical history

Advocate Advocate wwwenvirohealthactionorgwwwenvirohealthactionorg

Local AdvocacyLocal Advocacy Oregon Environmental CouncilOregon Environmental Council wwwoeconlineorgwwwoeconlineorg Oregon Collaborative on Health amp Oregon Collaborative on Health amp

EnvironmentEnvironment Healthy Environment ForumsHealthy Environment Forums Oregon Center for Environmental HealthOregon Center for Environmental Health wwworegon-healthorgwwworegon-healthorg Healthcare without HarmHealthcare without Harm Hospitals for Healthy Environment (h2e)Hospitals for Healthy Environment (h2e) Oregon PSROregon PSR wwworegonpsrorgwwworegonpsrorg Environmental Health-In Harmrsquos Way Environmental Health-In Harmrsquos Way

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

A 52 yr-old pt co increasing tremor A 52 yr-old pt co increasing tremor On PE the tremor is pill-rolling and On PE the tremor is pill-rolling and resolves with intention +Romberg resolves with intention +Romberg sign unstable tandem gaitsign unstable tandem gait

You make a preliminary diagnosis of You make a preliminary diagnosis of early Parkinsonrsquos diseaseearly Parkinsonrsquos disease

Wife mentions reading about Wife mentions reading about environmental links to PD pt is a environmental links to PD pt is a farmer and has used pesticides for farmer and has used pesticides for years Could this be related to his years Could this be related to his diseasedisease

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

Paraquat rotenone organophosphates Paraquat rotenone organophosphates dieldrin and fungicides maneb amp dieldrin and fungicides maneb amp mancozeb implicatedmancozeb implicated

MPTP a designer heroin-like drug MPTP a designer heroin-like drug causes Parkinsonian syndrome in causes Parkinsonian syndrome in addictsaddicts

Higher incidence in industrialized Higher incidence in industrialized countries greatest risk in rural countries greatest risk in rural areasfarms prolonged pesticide useareasfarms prolonged pesticide use

Case control studies herbicide or Case control studies herbicide or insecticide exposure 3-4x likelyinsecticide exposure 3-4x likely

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

2005 Brown T et al Meta-analysis 2005 Brown T et al Meta-analysis of epidemi-ologic amp toxicologic of epidemi-ologic amp toxicologic studies since 1983 studies since 1983

Verified most of these links noting Verified most of these links noting limitations in study designs limitations in study designs

Conclusion ldquogeneric association btw Conclusion ldquogeneric association btw pesticide exposure amp PD exists but pesticide exposure amp PD exists but is insufficient tohellipconcludehellipa causal is insufficient tohellipconcludehellipa causal relationshiprdquo relationshiprdquo

Pesticides Genes amp PDPesticides Genes amp PD

Dr W Langston of Parkinsonrsquos Dr W Langston of Parkinsonrsquos Institute ldquoAccelerating Research on Institute ldquoAccelerating Research on Genes and Environment in Genes and Environment in Parkinsonrsquos Diseaserdquo (2005)Parkinsonrsquos Diseaserdquo (2005)

Two PD studies underway one in Two PD studies underway one in pesticide applicators other in two pesticide applicators other in two CA counties with known heavy CA counties with known heavy exposureexposure

Other Health Impacts of Other Health Impacts of PesticidesPesticides

ArrhythmiasArrhythmiasAsthmaAsthmaLymphomas Brain tumorsLymphomas Brain tumorsAbnormal sperm countsAbnormal sperm countsBirth defects amp developmental delaysBirth defects amp developmental delaysHyperactivity amp behavioral problemsHyperactivity amp behavioral problemsDecreased endurance amp coordinationDecreased endurance amp coordinationNeurocognitive problemsNeurocognitive problemsPeripheral neuropathiesPeripheral neuropathies

Pesticides a Persistent Pesticides a Persistent ProblemProblem

Major classesMajor classes insecticides fungicides insecticides fungicides herbicides rodenticidesherbicides rodenticides

1997 Market1997 Market US $119 billion World $37 US $119 billion World $37 billionbillion

HistoryHistory synthetic-new to humans amp synthetic-new to humans amp environment since 1940s gt800 licensed environment since 1940s gt800 licensed ldquoactiverdquo ingredientsldquoactiverdquo ingredients

Manufacturers Manufacturers Bayer Aventis other drug Bayer Aventis other drug coco

Inherent toxicityInherent toxicity 140 pesticides considered 140 pesticides considered neurotoxic 37 are used on food ampor feedneurotoxic 37 are used on food ampor feed

Insecticide Sites of Insecticide Sites of ActionAction

Enzymes

Axonal Membranes

Ions (Na+ K+ Ca++ Cl-)

Enzymes

Neurotransmitters

Organochlorines

Pyrethroids

Casarett and Doullrsquos Toxicology The Basic Science of Poisons 5th Edition Ed Klaassen CD

McGraw-Hill New York 1996 P 649

Organophosphorus and

Carbamate Esters

Organophosphate PesticidesOrganophosphate PesticidesOccurrence and distribution in surface amp

ground water of the United States 1992-97

httpgawaterusgsgovpublicationsabstractsofr00-187html

Background Pesticide Background Pesticide Exposures WidespreadExposures Widespread

Reported useReported use 98 of families 80 during 98 of families 80 during pregnancypregnancy

In HumansIn Humans detectable chlorpyrifos detectable chlorpyrifos metabolites in 92 of childrenrsquos 82 of metabolites in 92 of childrenrsquos 82 of adultsrsquo urine samplesadultsrsquo urine samples

In FoodIn Food residues of at least one pesticide on residues of at least one pesticide on 72 fruits amp vegetables72 fruits amp vegetables

In HomesIn Homes 3 to 9 pesticide residues found3 to 9 pesticide residues found

In AirIn Air indoor levels 10-100X higher than indoor levels 10-100X higher than outdooroutdoor

In WaterIn Water gt90 stream samples 50 of gt90 stream samples 50 of wellswells

Sources of PesticidesSources of Pesticides

Household uses lawn amp garden Household uses lawn amp garden sprays exterminators flea collarssprays exterminators flea collars

Household dust (tracking in on shoes)Household dust (tracking in on shoes)

Public schools hospitals parks Public schools hospitals parks childcare facilitieschildcare facilities

Agricultural uses amp workersrsquo clothesAgricultural uses amp workersrsquo clothes

Non-organic foodsNon-organic foods

Breast milkBreast milk

Strategies to Reduces Strategies to Reduces Exposure to Home amp Garden Exposure to Home amp Garden

Pesticides in OregonPesticides in OregonPolicy SolutionsPolicy Solutions OR pesticide use reporting system OR pesticide use reporting system

(1999) finally funded 2005(1999) finally funded 2005 Educate homeowners re nontoxic Educate homeowners re nontoxic

options options Enc pet owners to use flea combs and Enc pet owners to use flea combs and

vacuuming to control fleasvacuuming to control fleas Enc public places to use Integrated Enc public places to use Integrated

Pest Management (IPM) ie Pesticide Pest Management (IPM) ie Pesticide Free ParksFree Parks

What YOU Can Do about What YOU Can Do about PesticidesPesticides

Advise PatientsAdvise Patients Regularly dustRegularly dust Use Integrated Pest Management Use Integrated Pest Management Cleanremove shoes outsideCleanremove shoes outside Keep contaminated clothes separateKeep contaminated clothes separate Buy sustainably grown foodBuy sustainably grown food Store food in secure nontoxic Store food in secure nontoxic

containerscontainers

Mercury amp Women of Mercury amp Women of Childbearing AgeChildbearing Age

A 32 yo G0P0 woman of A 32 yo G0P0 woman of childbearing age (WCBA) childbearing age (WCBA) presents for annual PE presents for annual PE

PMH negativePMH negative

Social hx husband is Social hx husband is recreational fisherman recreational fisherman

Contemplating pregnancy Contemplating pregnancy

Should she avoid fish Should she avoid fish because of mercury risks because of mercury risks to the fetusto the fetus

Mercury amp WCBAMercury amp WCBA

gt10gt10 of WCBA exceed safe limit of of WCBA exceed safe limit of 1ugkgday1ugkgday

5050 of women of women who eat fishwho eat fish exceed exceed limitlimit

5757 of WCBA have Hg levels of WCBA have Hg levels concerning for adverse effects concerning for adverse effects (CDC (CDC Natrsquol Report 0705Natrsquol Report 0705))

Higher risk Higher risk 300 000 childrenyear 300 000 childrenyear subsistence fishers immigrants subsistence fishers immigrants Native AmericansNative Americans

Mercury amp WCBAMercury amp WCBA

Hg enters tissues variable excretionHg enters tissues variable excretion Breast Milk PCBs DDT amp other Breast Milk PCBs DDT amp other

pesticides dioxins dibenzofurans pesticides dioxins dibenzofurans toxic flame retardants amp heavy toxic flame retardants amp heavy metals (Pb amp Hg) metals (Pb amp Hg)

No bio-accumulation in milk but No bio-accumulation in milk but levels in fish-eaters may exceed levels in fish-eaters may exceed unexposed women by 100x unexposed women by 100x

Scientific evidence indicates Scientific evidence indicates advantages of breast-feeding advantages of breast-feeding outweigh riskshellipoutweigh riskshellip

Neuro Effects of MercuryNeuro Effects of Mercury

Cerebral palsyCerebral palsy MRDDMRDD disequilibrium ataxiadisequilibrium ataxia hearing lossdeafnesshearing lossdeafness visual visual

impairmentblindnessimpairmentblindness peripheral neuropathyperipheral neuropathy parasthesiasparasthesias tremors seizures tremors seizures abnl reflexes amp muscle toneabnl reflexes amp muscle tone Psychiatric disturbances Psychiatric disturbances

Mercury a Persistent Mercury a Persistent ProblemProblem

PoisoningsPoisonings Minamata 1950s amp Iraq Minamata 1950s amp Iraq 19711971

Nationally ~Nationally ~160 tons of Hg annually160 tons of Hg annually In OregonIn Oregon ~ ~4500 lbs annually4500 lbs annually Lack of regulationLack of regulation In OR 10 facilities In OR 10 facilities

report Hg release-none has a permit or is report Hg release-none has a permit or is required to monitor emissions by staterequired to monitor emissions by state

Fish AdvisoriesFish Advisories in 2004 45 states had in 2004 45 states had gt2000 warnings Oregon lists advisories gt2000 warnings Oregon lists advisories for 12 water bodies inc Willamette for 12 water bodies inc Willamette

Atmospheric HgAtmospheric Hg

The Mercury CycleThe Mercury Cycle

MercuryMercuryDeclining Threshold of Declining Threshold of

HarmHarm

2000199019801970001

01

1

10

100

YEAR

Level associated with harmful effectRegulatory standard (maximum safe exposure or high end exposure from allowed fish contamination)

FDA WHO

EPA

ATSDR

DA

ILY

IN

TA

KE

(mic

rogr

ams

kg

day

Hg)

Sources of MercurySources of MercuryIndustrial emissions Industrial emissions

coal fired plantscoal fired plantsMunicipal amp medical Municipal amp medical

waste incineratorswaste incineratorsAbandoned Hg amp gold Abandoned Hg amp gold

minesminesNatural off-gassing Natural off-gassing Dental amalgamsDental amalgamsBioaccumulation in Bioaccumulation in

foods esp fishfoods esp fishOld thermometers BP Old thermometers BP

cuffs amp auto cuffs amp auto switchesswitches

Strategies to Reduce Strategies to Reduce Mercury Pollution in Mercury Pollution in

OregonOregonPolicy SolutionsPolicy Solutions Mercury Solutions Act of 2001Mercury Solutions Act of 2001 Ensure safe collection amp recyclingEnsure safe collection amp recycling Clean up abandoned mines and Clean up abandoned mines and

SuperfundsSuperfunds Reduce Hg emissions from health Reduce Hg emissions from health

care facilitiescare facilities Inc Hg in applicable DEQ air amp Inc Hg in applicable DEQ air amp

water permitswater permits Coal burning power plant Boardman Coal burning power plant Boardman

OR OR Implement OR Executive OrderImplement OR Executive Order

What YOU Can Do about What YOU Can Do about MercuryMercury

Advise PatientsAdvise Patients Provide Provide An Expectant Motherrsquos Guide to An Expectant Motherrsquos Guide to

Eating Fish in Oregon (DHS) Eating Fish in Oregon (DHS) in waiting in waiting roomsrooms

Rec WCBA and children avoid fish wHgRec WCBA and children avoid fish wHg Enc WCBA to consume low-fat dietEnc WCBA to consume low-fat diet Recycle old Hg thermometers Recycle old Hg thermometers

thermostats amp fluorescent light tubesthermostats amp fluorescent light tubes Have car checked for Hg switches at Have car checked for Hg switches at

participating auto shop (free participating auto shop (free replacement)replacement)

Use digital thermometers amp thermostatsUse digital thermometers amp thermostats

SummarySummary Chronic Diseases are prevalent Toxic Chronic Diseases are prevalent Toxic

exposures are possible exposures are possible preventablepreventable contributorscontributors

Pesticides amp risk of Parkinsonrsquos and Mercury Pesticides amp risk of Parkinsonrsquos and Mercury risks to WCBA are more understood than most risks to WCBA are more understood than most toxins and other chronic diseasestoxins and other chronic diseases

Apparent toxicity at high doses should be a Apparent toxicity at high doses should be a red flag for possible harm from low dose red flag for possible harm from low dose chronic exposureschronic exposures

Since ldquoproofrdquo of harm materializes slowly Since ldquoproofrdquo of harm materializes slowly generations are at risk and may be harmed generations are at risk and may be harmed before adequate regulatory response occursbefore adequate regulatory response occurs

Kaiser amp HCWHh2eKaiser amp HCWHh2e

Clean Diesel Hospital Zones ProjectClean Diesel Hospital Zones Project Healthy Food in Healthcare InitiativeHealthy Food in Healthcare Initiative Green Building PVC and DEHP free Green Building PVC and DEHP free

NICU NICU Environmentally preferable purchasing Environmentally preferable purchasing

policypolicy Making Medicine Mercury Free Award Making Medicine Mercury Free Award h2e Environmental Leadership Award h2e Environmental Leadership Award

20022002

What Can You DoWhat Can You Do

Be aware of environmental toxins amp Be aware of environmental toxins amp their possible links to chronic diseasestheir possible links to chronic diseases

Provide advice amp education on Provide advice amp education on prevention andor minimizing prevention andor minimizing exposures or refer appropriately exposures or refer appropriately

Incorporate environmental questions Incorporate environmental questions into clinical historyinto clinical history

Advocate Advocate wwwenvirohealthactionorgwwwenvirohealthactionorg

Local AdvocacyLocal Advocacy Oregon Environmental CouncilOregon Environmental Council wwwoeconlineorgwwwoeconlineorg Oregon Collaborative on Health amp Oregon Collaborative on Health amp

EnvironmentEnvironment Healthy Environment ForumsHealthy Environment Forums Oregon Center for Environmental HealthOregon Center for Environmental Health wwworegon-healthorgwwworegon-healthorg Healthcare without HarmHealthcare without Harm Hospitals for Healthy Environment (h2e)Hospitals for Healthy Environment (h2e) Oregon PSROregon PSR wwworegonpsrorgwwworegonpsrorg Environmental Health-In Harmrsquos Way Environmental Health-In Harmrsquos Way

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

Paraquat rotenone organophosphates Paraquat rotenone organophosphates dieldrin and fungicides maneb amp dieldrin and fungicides maneb amp mancozeb implicatedmancozeb implicated

MPTP a designer heroin-like drug MPTP a designer heroin-like drug causes Parkinsonian syndrome in causes Parkinsonian syndrome in addictsaddicts

Higher incidence in industrialized Higher incidence in industrialized countries greatest risk in rural countries greatest risk in rural areasfarms prolonged pesticide useareasfarms prolonged pesticide use

Case control studies herbicide or Case control studies herbicide or insecticide exposure 3-4x likelyinsecticide exposure 3-4x likely

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

2005 Brown T et al Meta-analysis 2005 Brown T et al Meta-analysis of epidemi-ologic amp toxicologic of epidemi-ologic amp toxicologic studies since 1983 studies since 1983

Verified most of these links noting Verified most of these links noting limitations in study designs limitations in study designs

Conclusion ldquogeneric association btw Conclusion ldquogeneric association btw pesticide exposure amp PD exists but pesticide exposure amp PD exists but is insufficient tohellipconcludehellipa causal is insufficient tohellipconcludehellipa causal relationshiprdquo relationshiprdquo

Pesticides Genes amp PDPesticides Genes amp PD

Dr W Langston of Parkinsonrsquos Dr W Langston of Parkinsonrsquos Institute ldquoAccelerating Research on Institute ldquoAccelerating Research on Genes and Environment in Genes and Environment in Parkinsonrsquos Diseaserdquo (2005)Parkinsonrsquos Diseaserdquo (2005)

Two PD studies underway one in Two PD studies underway one in pesticide applicators other in two pesticide applicators other in two CA counties with known heavy CA counties with known heavy exposureexposure

Other Health Impacts of Other Health Impacts of PesticidesPesticides

ArrhythmiasArrhythmiasAsthmaAsthmaLymphomas Brain tumorsLymphomas Brain tumorsAbnormal sperm countsAbnormal sperm countsBirth defects amp developmental delaysBirth defects amp developmental delaysHyperactivity amp behavioral problemsHyperactivity amp behavioral problemsDecreased endurance amp coordinationDecreased endurance amp coordinationNeurocognitive problemsNeurocognitive problemsPeripheral neuropathiesPeripheral neuropathies

Pesticides a Persistent Pesticides a Persistent ProblemProblem

Major classesMajor classes insecticides fungicides insecticides fungicides herbicides rodenticidesherbicides rodenticides

1997 Market1997 Market US $119 billion World $37 US $119 billion World $37 billionbillion

HistoryHistory synthetic-new to humans amp synthetic-new to humans amp environment since 1940s gt800 licensed environment since 1940s gt800 licensed ldquoactiverdquo ingredientsldquoactiverdquo ingredients

Manufacturers Manufacturers Bayer Aventis other drug Bayer Aventis other drug coco

Inherent toxicityInherent toxicity 140 pesticides considered 140 pesticides considered neurotoxic 37 are used on food ampor feedneurotoxic 37 are used on food ampor feed

Insecticide Sites of Insecticide Sites of ActionAction

Enzymes

Axonal Membranes

Ions (Na+ K+ Ca++ Cl-)

Enzymes

Neurotransmitters

Organochlorines

Pyrethroids

Casarett and Doullrsquos Toxicology The Basic Science of Poisons 5th Edition Ed Klaassen CD

McGraw-Hill New York 1996 P 649

Organophosphorus and

Carbamate Esters

Organophosphate PesticidesOrganophosphate PesticidesOccurrence and distribution in surface amp

ground water of the United States 1992-97

httpgawaterusgsgovpublicationsabstractsofr00-187html

Background Pesticide Background Pesticide Exposures WidespreadExposures Widespread

Reported useReported use 98 of families 80 during 98 of families 80 during pregnancypregnancy

In HumansIn Humans detectable chlorpyrifos detectable chlorpyrifos metabolites in 92 of childrenrsquos 82 of metabolites in 92 of childrenrsquos 82 of adultsrsquo urine samplesadultsrsquo urine samples

In FoodIn Food residues of at least one pesticide on residues of at least one pesticide on 72 fruits amp vegetables72 fruits amp vegetables

In HomesIn Homes 3 to 9 pesticide residues found3 to 9 pesticide residues found

In AirIn Air indoor levels 10-100X higher than indoor levels 10-100X higher than outdooroutdoor

In WaterIn Water gt90 stream samples 50 of gt90 stream samples 50 of wellswells

Sources of PesticidesSources of Pesticides

Household uses lawn amp garden Household uses lawn amp garden sprays exterminators flea collarssprays exterminators flea collars

Household dust (tracking in on shoes)Household dust (tracking in on shoes)

Public schools hospitals parks Public schools hospitals parks childcare facilitieschildcare facilities

Agricultural uses amp workersrsquo clothesAgricultural uses amp workersrsquo clothes

Non-organic foodsNon-organic foods

Breast milkBreast milk

Strategies to Reduces Strategies to Reduces Exposure to Home amp Garden Exposure to Home amp Garden

Pesticides in OregonPesticides in OregonPolicy SolutionsPolicy Solutions OR pesticide use reporting system OR pesticide use reporting system

(1999) finally funded 2005(1999) finally funded 2005 Educate homeowners re nontoxic Educate homeowners re nontoxic

options options Enc pet owners to use flea combs and Enc pet owners to use flea combs and

vacuuming to control fleasvacuuming to control fleas Enc public places to use Integrated Enc public places to use Integrated

Pest Management (IPM) ie Pesticide Pest Management (IPM) ie Pesticide Free ParksFree Parks

What YOU Can Do about What YOU Can Do about PesticidesPesticides

Advise PatientsAdvise Patients Regularly dustRegularly dust Use Integrated Pest Management Use Integrated Pest Management Cleanremove shoes outsideCleanremove shoes outside Keep contaminated clothes separateKeep contaminated clothes separate Buy sustainably grown foodBuy sustainably grown food Store food in secure nontoxic Store food in secure nontoxic

containerscontainers

Mercury amp Women of Mercury amp Women of Childbearing AgeChildbearing Age

A 32 yo G0P0 woman of A 32 yo G0P0 woman of childbearing age (WCBA) childbearing age (WCBA) presents for annual PE presents for annual PE

PMH negativePMH negative

Social hx husband is Social hx husband is recreational fisherman recreational fisherman

Contemplating pregnancy Contemplating pregnancy

Should she avoid fish Should she avoid fish because of mercury risks because of mercury risks to the fetusto the fetus

Mercury amp WCBAMercury amp WCBA

gt10gt10 of WCBA exceed safe limit of of WCBA exceed safe limit of 1ugkgday1ugkgday

5050 of women of women who eat fishwho eat fish exceed exceed limitlimit

5757 of WCBA have Hg levels of WCBA have Hg levels concerning for adverse effects concerning for adverse effects (CDC (CDC Natrsquol Report 0705Natrsquol Report 0705))

Higher risk Higher risk 300 000 childrenyear 300 000 childrenyear subsistence fishers immigrants subsistence fishers immigrants Native AmericansNative Americans

Mercury amp WCBAMercury amp WCBA

Hg enters tissues variable excretionHg enters tissues variable excretion Breast Milk PCBs DDT amp other Breast Milk PCBs DDT amp other

pesticides dioxins dibenzofurans pesticides dioxins dibenzofurans toxic flame retardants amp heavy toxic flame retardants amp heavy metals (Pb amp Hg) metals (Pb amp Hg)

No bio-accumulation in milk but No bio-accumulation in milk but levels in fish-eaters may exceed levels in fish-eaters may exceed unexposed women by 100x unexposed women by 100x

Scientific evidence indicates Scientific evidence indicates advantages of breast-feeding advantages of breast-feeding outweigh riskshellipoutweigh riskshellip

Neuro Effects of MercuryNeuro Effects of Mercury

Cerebral palsyCerebral palsy MRDDMRDD disequilibrium ataxiadisequilibrium ataxia hearing lossdeafnesshearing lossdeafness visual visual

impairmentblindnessimpairmentblindness peripheral neuropathyperipheral neuropathy parasthesiasparasthesias tremors seizures tremors seizures abnl reflexes amp muscle toneabnl reflexes amp muscle tone Psychiatric disturbances Psychiatric disturbances

Mercury a Persistent Mercury a Persistent ProblemProblem

PoisoningsPoisonings Minamata 1950s amp Iraq Minamata 1950s amp Iraq 19711971

Nationally ~Nationally ~160 tons of Hg annually160 tons of Hg annually In OregonIn Oregon ~ ~4500 lbs annually4500 lbs annually Lack of regulationLack of regulation In OR 10 facilities In OR 10 facilities

report Hg release-none has a permit or is report Hg release-none has a permit or is required to monitor emissions by staterequired to monitor emissions by state

Fish AdvisoriesFish Advisories in 2004 45 states had in 2004 45 states had gt2000 warnings Oregon lists advisories gt2000 warnings Oregon lists advisories for 12 water bodies inc Willamette for 12 water bodies inc Willamette

Atmospheric HgAtmospheric Hg

The Mercury CycleThe Mercury Cycle

MercuryMercuryDeclining Threshold of Declining Threshold of

HarmHarm

2000199019801970001

01

1

10

100

YEAR

Level associated with harmful effectRegulatory standard (maximum safe exposure or high end exposure from allowed fish contamination)

FDA WHO

EPA

ATSDR

DA

ILY

IN

TA

KE

(mic

rogr

ams

kg

day

Hg)

Sources of MercurySources of MercuryIndustrial emissions Industrial emissions

coal fired plantscoal fired plantsMunicipal amp medical Municipal amp medical

waste incineratorswaste incineratorsAbandoned Hg amp gold Abandoned Hg amp gold

minesminesNatural off-gassing Natural off-gassing Dental amalgamsDental amalgamsBioaccumulation in Bioaccumulation in

foods esp fishfoods esp fishOld thermometers BP Old thermometers BP

cuffs amp auto cuffs amp auto switchesswitches

Strategies to Reduce Strategies to Reduce Mercury Pollution in Mercury Pollution in

OregonOregonPolicy SolutionsPolicy Solutions Mercury Solutions Act of 2001Mercury Solutions Act of 2001 Ensure safe collection amp recyclingEnsure safe collection amp recycling Clean up abandoned mines and Clean up abandoned mines and

SuperfundsSuperfunds Reduce Hg emissions from health Reduce Hg emissions from health

care facilitiescare facilities Inc Hg in applicable DEQ air amp Inc Hg in applicable DEQ air amp

water permitswater permits Coal burning power plant Boardman Coal burning power plant Boardman

OR OR Implement OR Executive OrderImplement OR Executive Order

What YOU Can Do about What YOU Can Do about MercuryMercury

Advise PatientsAdvise Patients Provide Provide An Expectant Motherrsquos Guide to An Expectant Motherrsquos Guide to

Eating Fish in Oregon (DHS) Eating Fish in Oregon (DHS) in waiting in waiting roomsrooms

Rec WCBA and children avoid fish wHgRec WCBA and children avoid fish wHg Enc WCBA to consume low-fat dietEnc WCBA to consume low-fat diet Recycle old Hg thermometers Recycle old Hg thermometers

thermostats amp fluorescent light tubesthermostats amp fluorescent light tubes Have car checked for Hg switches at Have car checked for Hg switches at

participating auto shop (free participating auto shop (free replacement)replacement)

Use digital thermometers amp thermostatsUse digital thermometers amp thermostats

SummarySummary Chronic Diseases are prevalent Toxic Chronic Diseases are prevalent Toxic

exposures are possible exposures are possible preventablepreventable contributorscontributors

Pesticides amp risk of Parkinsonrsquos and Mercury Pesticides amp risk of Parkinsonrsquos and Mercury risks to WCBA are more understood than most risks to WCBA are more understood than most toxins and other chronic diseasestoxins and other chronic diseases

Apparent toxicity at high doses should be a Apparent toxicity at high doses should be a red flag for possible harm from low dose red flag for possible harm from low dose chronic exposureschronic exposures

Since ldquoproofrdquo of harm materializes slowly Since ldquoproofrdquo of harm materializes slowly generations are at risk and may be harmed generations are at risk and may be harmed before adequate regulatory response occursbefore adequate regulatory response occurs

Kaiser amp HCWHh2eKaiser amp HCWHh2e

Clean Diesel Hospital Zones ProjectClean Diesel Hospital Zones Project Healthy Food in Healthcare InitiativeHealthy Food in Healthcare Initiative Green Building PVC and DEHP free Green Building PVC and DEHP free

NICU NICU Environmentally preferable purchasing Environmentally preferable purchasing

policypolicy Making Medicine Mercury Free Award Making Medicine Mercury Free Award h2e Environmental Leadership Award h2e Environmental Leadership Award

20022002

What Can You DoWhat Can You Do

Be aware of environmental toxins amp Be aware of environmental toxins amp their possible links to chronic diseasestheir possible links to chronic diseases

Provide advice amp education on Provide advice amp education on prevention andor minimizing prevention andor minimizing exposures or refer appropriately exposures or refer appropriately

Incorporate environmental questions Incorporate environmental questions into clinical historyinto clinical history

Advocate Advocate wwwenvirohealthactionorgwwwenvirohealthactionorg

Local AdvocacyLocal Advocacy Oregon Environmental CouncilOregon Environmental Council wwwoeconlineorgwwwoeconlineorg Oregon Collaborative on Health amp Oregon Collaborative on Health amp

EnvironmentEnvironment Healthy Environment ForumsHealthy Environment Forums Oregon Center for Environmental HealthOregon Center for Environmental Health wwworegon-healthorgwwworegon-healthorg Healthcare without HarmHealthcare without Harm Hospitals for Healthy Environment (h2e)Hospitals for Healthy Environment (h2e) Oregon PSROregon PSR wwworegonpsrorgwwworegonpsrorg Environmental Health-In Harmrsquos Way Environmental Health-In Harmrsquos Way

Pesticides amp ParkinsonrsquosPesticides amp Parkinsonrsquos

2005 Brown T et al Meta-analysis 2005 Brown T et al Meta-analysis of epidemi-ologic amp toxicologic of epidemi-ologic amp toxicologic studies since 1983 studies since 1983

Verified most of these links noting Verified most of these links noting limitations in study designs limitations in study designs

Conclusion ldquogeneric association btw Conclusion ldquogeneric association btw pesticide exposure amp PD exists but pesticide exposure amp PD exists but is insufficient tohellipconcludehellipa causal is insufficient tohellipconcludehellipa causal relationshiprdquo relationshiprdquo

Pesticides Genes amp PDPesticides Genes amp PD

Dr W Langston of Parkinsonrsquos Dr W Langston of Parkinsonrsquos Institute ldquoAccelerating Research on Institute ldquoAccelerating Research on Genes and Environment in Genes and Environment in Parkinsonrsquos Diseaserdquo (2005)Parkinsonrsquos Diseaserdquo (2005)

Two PD studies underway one in Two PD studies underway one in pesticide applicators other in two pesticide applicators other in two CA counties with known heavy CA counties with known heavy exposureexposure

Other Health Impacts of Other Health Impacts of PesticidesPesticides

ArrhythmiasArrhythmiasAsthmaAsthmaLymphomas Brain tumorsLymphomas Brain tumorsAbnormal sperm countsAbnormal sperm countsBirth defects amp developmental delaysBirth defects amp developmental delaysHyperactivity amp behavioral problemsHyperactivity amp behavioral problemsDecreased endurance amp coordinationDecreased endurance amp coordinationNeurocognitive problemsNeurocognitive problemsPeripheral neuropathiesPeripheral neuropathies

Pesticides a Persistent Pesticides a Persistent ProblemProblem

Major classesMajor classes insecticides fungicides insecticides fungicides herbicides rodenticidesherbicides rodenticides

1997 Market1997 Market US $119 billion World $37 US $119 billion World $37 billionbillion

HistoryHistory synthetic-new to humans amp synthetic-new to humans amp environment since 1940s gt800 licensed environment since 1940s gt800 licensed ldquoactiverdquo ingredientsldquoactiverdquo ingredients

Manufacturers Manufacturers Bayer Aventis other drug Bayer Aventis other drug coco

Inherent toxicityInherent toxicity 140 pesticides considered 140 pesticides considered neurotoxic 37 are used on food ampor feedneurotoxic 37 are used on food ampor feed

Insecticide Sites of Insecticide Sites of ActionAction

Enzymes

Axonal Membranes

Ions (Na+ K+ Ca++ Cl-)

Enzymes

Neurotransmitters

Organochlorines

Pyrethroids

Casarett and Doullrsquos Toxicology The Basic Science of Poisons 5th Edition Ed Klaassen CD

McGraw-Hill New York 1996 P 649

Organophosphorus and

Carbamate Esters

Organophosphate PesticidesOrganophosphate PesticidesOccurrence and distribution in surface amp

ground water of the United States 1992-97

httpgawaterusgsgovpublicationsabstractsofr00-187html

Background Pesticide Background Pesticide Exposures WidespreadExposures Widespread

Reported useReported use 98 of families 80 during 98 of families 80 during pregnancypregnancy

In HumansIn Humans detectable chlorpyrifos detectable chlorpyrifos metabolites in 92 of childrenrsquos 82 of metabolites in 92 of childrenrsquos 82 of adultsrsquo urine samplesadultsrsquo urine samples

In FoodIn Food residues of at least one pesticide on residues of at least one pesticide on 72 fruits amp vegetables72 fruits amp vegetables

In HomesIn Homes 3 to 9 pesticide residues found3 to 9 pesticide residues found

In AirIn Air indoor levels 10-100X higher than indoor levels 10-100X higher than outdooroutdoor

In WaterIn Water gt90 stream samples 50 of gt90 stream samples 50 of wellswells

Sources of PesticidesSources of Pesticides

Household uses lawn amp garden Household uses lawn amp garden sprays exterminators flea collarssprays exterminators flea collars

Household dust (tracking in on shoes)Household dust (tracking in on shoes)

Public schools hospitals parks Public schools hospitals parks childcare facilitieschildcare facilities

Agricultural uses amp workersrsquo clothesAgricultural uses amp workersrsquo clothes

Non-organic foodsNon-organic foods

Breast milkBreast milk

Strategies to Reduces Strategies to Reduces Exposure to Home amp Garden Exposure to Home amp Garden

Pesticides in OregonPesticides in OregonPolicy SolutionsPolicy Solutions OR pesticide use reporting system OR pesticide use reporting system

(1999) finally funded 2005(1999) finally funded 2005 Educate homeowners re nontoxic Educate homeowners re nontoxic

options options Enc pet owners to use flea combs and Enc pet owners to use flea combs and

vacuuming to control fleasvacuuming to control fleas Enc public places to use Integrated Enc public places to use Integrated

Pest Management (IPM) ie Pesticide Pest Management (IPM) ie Pesticide Free ParksFree Parks

What YOU Can Do about What YOU Can Do about PesticidesPesticides

Advise PatientsAdvise Patients Regularly dustRegularly dust Use Integrated Pest Management Use Integrated Pest Management Cleanremove shoes outsideCleanremove shoes outside Keep contaminated clothes separateKeep contaminated clothes separate Buy sustainably grown foodBuy sustainably grown food Store food in secure nontoxic Store food in secure nontoxic

containerscontainers

Mercury amp Women of Mercury amp Women of Childbearing AgeChildbearing Age

A 32 yo G0P0 woman of A 32 yo G0P0 woman of childbearing age (WCBA) childbearing age (WCBA) presents for annual PE presents for annual PE

PMH negativePMH negative

Social hx husband is Social hx husband is recreational fisherman recreational fisherman

Contemplating pregnancy Contemplating pregnancy

Should she avoid fish Should she avoid fish because of mercury risks because of mercury risks to the fetusto the fetus

Mercury amp WCBAMercury amp WCBA

gt10gt10 of WCBA exceed safe limit of of WCBA exceed safe limit of 1ugkgday1ugkgday

5050 of women of women who eat fishwho eat fish exceed exceed limitlimit

5757 of WCBA have Hg levels of WCBA have Hg levels concerning for adverse effects concerning for adverse effects (CDC (CDC Natrsquol Report 0705Natrsquol Report 0705))

Higher risk Higher risk 300 000 childrenyear 300 000 childrenyear subsistence fishers immigrants subsistence fishers immigrants Native AmericansNative Americans

Mercury amp WCBAMercury amp WCBA

Hg enters tissues variable excretionHg enters tissues variable excretion Breast Milk PCBs DDT amp other Breast Milk PCBs DDT amp other

pesticides dioxins dibenzofurans pesticides dioxins dibenzofurans toxic flame retardants amp heavy toxic flame retardants amp heavy metals (Pb amp Hg) metals (Pb amp Hg)

No bio-accumulation in milk but No bio-accumulation in milk but levels in fish-eaters may exceed levels in fish-eaters may exceed unexposed women by 100x unexposed women by 100x

Scientific evidence indicates Scientific evidence indicates advantages of breast-feeding advantages of breast-feeding outweigh riskshellipoutweigh riskshellip

Neuro Effects of MercuryNeuro Effects of Mercury

Cerebral palsyCerebral palsy MRDDMRDD disequilibrium ataxiadisequilibrium ataxia hearing lossdeafnesshearing lossdeafness visual visual

impairmentblindnessimpairmentblindness peripheral neuropathyperipheral neuropathy parasthesiasparasthesias tremors seizures tremors seizures abnl reflexes amp muscle toneabnl reflexes amp muscle tone Psychiatric disturbances Psychiatric disturbances

Mercury a Persistent Mercury a Persistent ProblemProblem

PoisoningsPoisonings Minamata 1950s amp Iraq Minamata 1950s amp Iraq 19711971

Nationally ~Nationally ~160 tons of Hg annually160 tons of Hg annually In OregonIn Oregon ~ ~4500 lbs annually4500 lbs annually Lack of regulationLack of regulation In OR 10 facilities In OR 10 facilities

report Hg release-none has a permit or is report Hg release-none has a permit or is required to monitor emissions by staterequired to monitor emissions by state

Fish AdvisoriesFish Advisories in 2004 45 states had in 2004 45 states had gt2000 warnings Oregon lists advisories gt2000 warnings Oregon lists advisories for 12 water bodies inc Willamette for 12 water bodies inc Willamette

Atmospheric HgAtmospheric Hg

The Mercury CycleThe Mercury Cycle

MercuryMercuryDeclining Threshold of Declining Threshold of

HarmHarm

2000199019801970001

01

1

10

100

YEAR

Level associated with harmful effectRegulatory standard (maximum safe exposure or high end exposure from allowed fish contamination)

FDA WHO

EPA

ATSDR

DA

ILY

IN

TA

KE

(mic

rogr

ams

kg

day

Hg)

Sources of MercurySources of MercuryIndustrial emissions Industrial emissions

coal fired plantscoal fired plantsMunicipal amp medical Municipal amp medical

waste incineratorswaste incineratorsAbandoned Hg amp gold Abandoned Hg amp gold

minesminesNatural off-gassing Natural off-gassing Dental amalgamsDental amalgamsBioaccumulation in Bioaccumulation in

foods esp fishfoods esp fishOld thermometers BP Old thermometers BP

cuffs amp auto cuffs amp auto switchesswitches

Strategies to Reduce Strategies to Reduce Mercury Pollution in Mercury Pollution in

OregonOregonPolicy SolutionsPolicy Solutions Mercury Solutions Act of 2001Mercury Solutions Act of 2001 Ensure safe collection amp recyclingEnsure safe collection amp recycling Clean up abandoned mines and Clean up abandoned mines and

SuperfundsSuperfunds Reduce Hg emissions from health Reduce Hg emissions from health

care facilitiescare facilities Inc Hg in applicable DEQ air amp Inc Hg in applicable DEQ air amp

water permitswater permits Coal burning power plant Boardman Coal burning power plant Boardman

OR OR Implement OR Executive OrderImplement OR Executive Order

What YOU Can Do about What YOU Can Do about MercuryMercury

Advise PatientsAdvise Patients Provide Provide An Expectant Motherrsquos Guide to An Expectant Motherrsquos Guide to

Eating Fish in Oregon (DHS) Eating Fish in Oregon (DHS) in waiting in waiting roomsrooms

Rec WCBA and children avoid fish wHgRec WCBA and children avoid fish wHg Enc WCBA to consume low-fat dietEnc WCBA to consume low-fat diet Recycle old Hg thermometers Recycle old Hg thermometers

thermostats amp fluorescent light tubesthermostats amp fluorescent light tubes Have car checked for Hg switches at Have car checked for Hg switches at

participating auto shop (free participating auto shop (free replacement)replacement)

Use digital thermometers amp thermostatsUse digital thermometers amp thermostats

SummarySummary Chronic Diseases are prevalent Toxic Chronic Diseases are prevalent Toxic

exposures are possible exposures are possible preventablepreventable contributorscontributors

Pesticides amp risk of Parkinsonrsquos and Mercury Pesticides amp risk of Parkinsonrsquos and Mercury risks to WCBA are more understood than most risks to WCBA are more understood than most toxins and other chronic diseasestoxins and other chronic diseases

Apparent toxicity at high doses should be a Apparent toxicity at high doses should be a red flag for possible harm from low dose red flag for possible harm from low dose chronic exposureschronic exposures

Since ldquoproofrdquo of harm materializes slowly Since ldquoproofrdquo of harm materializes slowly generations are at risk and may be harmed generations are at risk and may be harmed before adequate regulatory response occursbefore adequate regulatory response occurs

Kaiser amp HCWHh2eKaiser amp HCWHh2e

Clean Diesel Hospital Zones ProjectClean Diesel Hospital Zones Project Healthy Food in Healthcare InitiativeHealthy Food in Healthcare Initiative Green Building PVC and DEHP free Green Building PVC and DEHP free

NICU NICU Environmentally preferable purchasing Environmentally preferable purchasing

policypolicy Making Medicine Mercury Free Award Making Medicine Mercury Free Award h2e Environmental Leadership Award h2e Environmental Leadership Award

20022002

What Can You DoWhat Can You Do

Be aware of environmental toxins amp Be aware of environmental toxins amp their possible links to chronic diseasestheir possible links to chronic diseases

Provide advice amp education on Provide advice amp education on prevention andor minimizing prevention andor minimizing exposures or refer appropriately exposures or refer appropriately

Incorporate environmental questions Incorporate environmental questions into clinical historyinto clinical history

Advocate Advocate wwwenvirohealthactionorgwwwenvirohealthactionorg

Local AdvocacyLocal Advocacy Oregon Environmental CouncilOregon Environmental Council wwwoeconlineorgwwwoeconlineorg Oregon Collaborative on Health amp Oregon Collaborative on Health amp

EnvironmentEnvironment Healthy Environment ForumsHealthy Environment Forums Oregon Center for Environmental HealthOregon Center for Environmental Health wwworegon-healthorgwwworegon-healthorg Healthcare without HarmHealthcare without Harm Hospitals for Healthy Environment (h2e)Hospitals for Healthy Environment (h2e) Oregon PSROregon PSR wwworegonpsrorgwwworegonpsrorg Environmental Health-In Harmrsquos Way Environmental Health-In Harmrsquos Way

Pesticides Genes amp PDPesticides Genes amp PD

Dr W Langston of Parkinsonrsquos Dr W Langston of Parkinsonrsquos Institute ldquoAccelerating Research on Institute ldquoAccelerating Research on Genes and Environment in Genes and Environment in Parkinsonrsquos Diseaserdquo (2005)Parkinsonrsquos Diseaserdquo (2005)

Two PD studies underway one in Two PD studies underway one in pesticide applicators other in two pesticide applicators other in two CA counties with known heavy CA counties with known heavy exposureexposure

Other Health Impacts of Other Health Impacts of PesticidesPesticides

ArrhythmiasArrhythmiasAsthmaAsthmaLymphomas Brain tumorsLymphomas Brain tumorsAbnormal sperm countsAbnormal sperm countsBirth defects amp developmental delaysBirth defects amp developmental delaysHyperactivity amp behavioral problemsHyperactivity amp behavioral problemsDecreased endurance amp coordinationDecreased endurance amp coordinationNeurocognitive problemsNeurocognitive problemsPeripheral neuropathiesPeripheral neuropathies

Pesticides a Persistent Pesticides a Persistent ProblemProblem

Major classesMajor classes insecticides fungicides insecticides fungicides herbicides rodenticidesherbicides rodenticides

1997 Market1997 Market US $119 billion World $37 US $119 billion World $37 billionbillion

HistoryHistory synthetic-new to humans amp synthetic-new to humans amp environment since 1940s gt800 licensed environment since 1940s gt800 licensed ldquoactiverdquo ingredientsldquoactiverdquo ingredients

Manufacturers Manufacturers Bayer Aventis other drug Bayer Aventis other drug coco

Inherent toxicityInherent toxicity 140 pesticides considered 140 pesticides considered neurotoxic 37 are used on food ampor feedneurotoxic 37 are used on food ampor feed

Insecticide Sites of Insecticide Sites of ActionAction

Enzymes

Axonal Membranes

Ions (Na+ K+ Ca++ Cl-)

Enzymes

Neurotransmitters

Organochlorines

Pyrethroids

Casarett and Doullrsquos Toxicology The Basic Science of Poisons 5th Edition Ed Klaassen CD

McGraw-Hill New York 1996 P 649

Organophosphorus and

Carbamate Esters

Organophosphate PesticidesOrganophosphate PesticidesOccurrence and distribution in surface amp

ground water of the United States 1992-97

httpgawaterusgsgovpublicationsabstractsofr00-187html

Background Pesticide Background Pesticide Exposures WidespreadExposures Widespread

Reported useReported use 98 of families 80 during 98 of families 80 during pregnancypregnancy

In HumansIn Humans detectable chlorpyrifos detectable chlorpyrifos metabolites in 92 of childrenrsquos 82 of metabolites in 92 of childrenrsquos 82 of adultsrsquo urine samplesadultsrsquo urine samples

In FoodIn Food residues of at least one pesticide on residues of at least one pesticide on 72 fruits amp vegetables72 fruits amp vegetables

In HomesIn Homes 3 to 9 pesticide residues found3 to 9 pesticide residues found

In AirIn Air indoor levels 10-100X higher than indoor levels 10-100X higher than outdooroutdoor

In WaterIn Water gt90 stream samples 50 of gt90 stream samples 50 of wellswells

Sources of PesticidesSources of Pesticides

Household uses lawn amp garden Household uses lawn amp garden sprays exterminators flea collarssprays exterminators flea collars

Household dust (tracking in on shoes)Household dust (tracking in on shoes)

Public schools hospitals parks Public schools hospitals parks childcare facilitieschildcare facilities

Agricultural uses amp workersrsquo clothesAgricultural uses amp workersrsquo clothes

Non-organic foodsNon-organic foods

Breast milkBreast milk

Strategies to Reduces Strategies to Reduces Exposure to Home amp Garden Exposure to Home amp Garden

Pesticides in OregonPesticides in OregonPolicy SolutionsPolicy Solutions OR pesticide use reporting system OR pesticide use reporting system

(1999) finally funded 2005(1999) finally funded 2005 Educate homeowners re nontoxic Educate homeowners re nontoxic

options options Enc pet owners to use flea combs and Enc pet owners to use flea combs and

vacuuming to control fleasvacuuming to control fleas Enc public places to use Integrated Enc public places to use Integrated

Pest Management (IPM) ie Pesticide Pest Management (IPM) ie Pesticide Free ParksFree Parks

What YOU Can Do about What YOU Can Do about PesticidesPesticides

Advise PatientsAdvise Patients Regularly dustRegularly dust Use Integrated Pest Management Use Integrated Pest Management Cleanremove shoes outsideCleanremove shoes outside Keep contaminated clothes separateKeep contaminated clothes separate Buy sustainably grown foodBuy sustainably grown food Store food in secure nontoxic Store food in secure nontoxic

containerscontainers

Mercury amp Women of Mercury amp Women of Childbearing AgeChildbearing Age

A 32 yo G0P0 woman of A 32 yo G0P0 woman of childbearing age (WCBA) childbearing age (WCBA) presents for annual PE presents for annual PE

PMH negativePMH negative

Social hx husband is Social hx husband is recreational fisherman recreational fisherman

Contemplating pregnancy Contemplating pregnancy

Should she avoid fish Should she avoid fish because of mercury risks because of mercury risks to the fetusto the fetus

Mercury amp WCBAMercury amp WCBA

gt10gt10 of WCBA exceed safe limit of of WCBA exceed safe limit of 1ugkgday1ugkgday

5050 of women of women who eat fishwho eat fish exceed exceed limitlimit

5757 of WCBA have Hg levels of WCBA have Hg levels concerning for adverse effects concerning for adverse effects (CDC (CDC Natrsquol Report 0705Natrsquol Report 0705))

Higher risk Higher risk 300 000 childrenyear 300 000 childrenyear subsistence fishers immigrants subsistence fishers immigrants Native AmericansNative Americans

Mercury amp WCBAMercury amp WCBA

Hg enters tissues variable excretionHg enters tissues variable excretion Breast Milk PCBs DDT amp other Breast Milk PCBs DDT amp other

pesticides dioxins dibenzofurans pesticides dioxins dibenzofurans toxic flame retardants amp heavy toxic flame retardants amp heavy metals (Pb amp Hg) metals (Pb amp Hg)

No bio-accumulation in milk but No bio-accumulation in milk but levels in fish-eaters may exceed levels in fish-eaters may exceed unexposed women by 100x unexposed women by 100x

Scientific evidence indicates Scientific evidence indicates advantages of breast-feeding advantages of breast-feeding outweigh riskshellipoutweigh riskshellip

Neuro Effects of MercuryNeuro Effects of Mercury

Cerebral palsyCerebral palsy MRDDMRDD disequilibrium ataxiadisequilibrium ataxia hearing lossdeafnesshearing lossdeafness visual visual

impairmentblindnessimpairmentblindness peripheral neuropathyperipheral neuropathy parasthesiasparasthesias tremors seizures tremors seizures abnl reflexes amp muscle toneabnl reflexes amp muscle tone Psychiatric disturbances Psychiatric disturbances

Mercury a Persistent Mercury a Persistent ProblemProblem

PoisoningsPoisonings Minamata 1950s amp Iraq Minamata 1950s amp Iraq 19711971

Nationally ~Nationally ~160 tons of Hg annually160 tons of Hg annually In OregonIn Oregon ~ ~4500 lbs annually4500 lbs annually Lack of regulationLack of regulation In OR 10 facilities In OR 10 facilities

report Hg release-none has a permit or is report Hg release-none has a permit or is required to monitor emissions by staterequired to monitor emissions by state

Fish AdvisoriesFish Advisories in 2004 45 states had in 2004 45 states had gt2000 warnings Oregon lists advisories gt2000 warnings Oregon lists advisories for 12 water bodies inc Willamette for 12 water bodies inc Willamette

Atmospheric HgAtmospheric Hg

The Mercury CycleThe Mercury Cycle

MercuryMercuryDeclining Threshold of Declining Threshold of

HarmHarm

2000199019801970001

01

1

10

100

YEAR

Level associated with harmful effectRegulatory standard (maximum safe exposure or high end exposure from allowed fish contamination)

FDA WHO

EPA

ATSDR

DA

ILY

IN

TA

KE

(mic

rogr

ams

kg

day

Hg)

Sources of MercurySources of MercuryIndustrial emissions Industrial emissions

coal fired plantscoal fired plantsMunicipal amp medical Municipal amp medical

waste incineratorswaste incineratorsAbandoned Hg amp gold Abandoned Hg amp gold

minesminesNatural off-gassing Natural off-gassing Dental amalgamsDental amalgamsBioaccumulation in Bioaccumulation in

foods esp fishfoods esp fishOld thermometers BP Old thermometers BP

cuffs amp auto cuffs amp auto switchesswitches

Strategies to Reduce Strategies to Reduce Mercury Pollution in Mercury Pollution in

OregonOregonPolicy SolutionsPolicy Solutions Mercury Solutions Act of 2001Mercury Solutions Act of 2001 Ensure safe collection amp recyclingEnsure safe collection amp recycling Clean up abandoned mines and Clean up abandoned mines and

SuperfundsSuperfunds Reduce Hg emissions from health Reduce Hg emissions from health

care facilitiescare facilities Inc Hg in applicable DEQ air amp Inc Hg in applicable DEQ air amp

water permitswater permits Coal burning power plant Boardman Coal burning power plant Boardman

OR OR Implement OR Executive OrderImplement OR Executive Order

What YOU Can Do about What YOU Can Do about MercuryMercury

Advise PatientsAdvise Patients Provide Provide An Expectant Motherrsquos Guide to An Expectant Motherrsquos Guide to

Eating Fish in Oregon (DHS) Eating Fish in Oregon (DHS) in waiting in waiting roomsrooms

Rec WCBA and children avoid fish wHgRec WCBA and children avoid fish wHg Enc WCBA to consume low-fat dietEnc WCBA to consume low-fat diet Recycle old Hg thermometers Recycle old Hg thermometers

thermostats amp fluorescent light tubesthermostats amp fluorescent light tubes Have car checked for Hg switches at Have car checked for Hg switches at

participating auto shop (free participating auto shop (free replacement)replacement)

Use digital thermometers amp thermostatsUse digital thermometers amp thermostats

SummarySummary Chronic Diseases are prevalent Toxic Chronic Diseases are prevalent Toxic

exposures are possible exposures are possible preventablepreventable contributorscontributors

Pesticides amp risk of Parkinsonrsquos and Mercury Pesticides amp risk of Parkinsonrsquos and Mercury risks to WCBA are more understood than most risks to WCBA are more understood than most toxins and other chronic diseasestoxins and other chronic diseases

Apparent toxicity at high doses should be a Apparent toxicity at high doses should be a red flag for possible harm from low dose red flag for possible harm from low dose chronic exposureschronic exposures

Since ldquoproofrdquo of harm materializes slowly Since ldquoproofrdquo of harm materializes slowly generations are at risk and may be harmed generations are at risk and may be harmed before adequate regulatory response occursbefore adequate regulatory response occurs

Kaiser amp HCWHh2eKaiser amp HCWHh2e

Clean Diesel Hospital Zones ProjectClean Diesel Hospital Zones Project Healthy Food in Healthcare InitiativeHealthy Food in Healthcare Initiative Green Building PVC and DEHP free Green Building PVC and DEHP free

NICU NICU Environmentally preferable purchasing Environmentally preferable purchasing

policypolicy Making Medicine Mercury Free Award Making Medicine Mercury Free Award h2e Environmental Leadership Award h2e Environmental Leadership Award

20022002

What Can You DoWhat Can You Do

Be aware of environmental toxins amp Be aware of environmental toxins amp their possible links to chronic diseasestheir possible links to chronic diseases

Provide advice amp education on Provide advice amp education on prevention andor minimizing prevention andor minimizing exposures or refer appropriately exposures or refer appropriately

Incorporate environmental questions Incorporate environmental questions into clinical historyinto clinical history

Advocate Advocate wwwenvirohealthactionorgwwwenvirohealthactionorg

Local AdvocacyLocal Advocacy Oregon Environmental CouncilOregon Environmental Council wwwoeconlineorgwwwoeconlineorg Oregon Collaborative on Health amp Oregon Collaborative on Health amp

EnvironmentEnvironment Healthy Environment ForumsHealthy Environment Forums Oregon Center for Environmental HealthOregon Center for Environmental Health wwworegon-healthorgwwworegon-healthorg Healthcare without HarmHealthcare without Harm Hospitals for Healthy Environment (h2e)Hospitals for Healthy Environment (h2e) Oregon PSROregon PSR wwworegonpsrorgwwworegonpsrorg Environmental Health-In Harmrsquos Way Environmental Health-In Harmrsquos Way

Other Health Impacts of Other Health Impacts of PesticidesPesticides

ArrhythmiasArrhythmiasAsthmaAsthmaLymphomas Brain tumorsLymphomas Brain tumorsAbnormal sperm countsAbnormal sperm countsBirth defects amp developmental delaysBirth defects amp developmental delaysHyperactivity amp behavioral problemsHyperactivity amp behavioral problemsDecreased endurance amp coordinationDecreased endurance amp coordinationNeurocognitive problemsNeurocognitive problemsPeripheral neuropathiesPeripheral neuropathies

Pesticides a Persistent Pesticides a Persistent ProblemProblem

Major classesMajor classes insecticides fungicides insecticides fungicides herbicides rodenticidesherbicides rodenticides

1997 Market1997 Market US $119 billion World $37 US $119 billion World $37 billionbillion

HistoryHistory synthetic-new to humans amp synthetic-new to humans amp environment since 1940s gt800 licensed environment since 1940s gt800 licensed ldquoactiverdquo ingredientsldquoactiverdquo ingredients

Manufacturers Manufacturers Bayer Aventis other drug Bayer Aventis other drug coco

Inherent toxicityInherent toxicity 140 pesticides considered 140 pesticides considered neurotoxic 37 are used on food ampor feedneurotoxic 37 are used on food ampor feed

Insecticide Sites of Insecticide Sites of ActionAction

Enzymes

Axonal Membranes

Ions (Na+ K+ Ca++ Cl-)

Enzymes

Neurotransmitters

Organochlorines

Pyrethroids

Casarett and Doullrsquos Toxicology The Basic Science of Poisons 5th Edition Ed Klaassen CD

McGraw-Hill New York 1996 P 649

Organophosphorus and

Carbamate Esters

Organophosphate PesticidesOrganophosphate PesticidesOccurrence and distribution in surface amp

ground water of the United States 1992-97

httpgawaterusgsgovpublicationsabstractsofr00-187html

Background Pesticide Background Pesticide Exposures WidespreadExposures Widespread

Reported useReported use 98 of families 80 during 98 of families 80 during pregnancypregnancy

In HumansIn Humans detectable chlorpyrifos detectable chlorpyrifos metabolites in 92 of childrenrsquos 82 of metabolites in 92 of childrenrsquos 82 of adultsrsquo urine samplesadultsrsquo urine samples

In FoodIn Food residues of at least one pesticide on residues of at least one pesticide on 72 fruits amp vegetables72 fruits amp vegetables

In HomesIn Homes 3 to 9 pesticide residues found3 to 9 pesticide residues found

In AirIn Air indoor levels 10-100X higher than indoor levels 10-100X higher than outdooroutdoor

In WaterIn Water gt90 stream samples 50 of gt90 stream samples 50 of wellswells

Sources of PesticidesSources of Pesticides

Household uses lawn amp garden Household uses lawn amp garden sprays exterminators flea collarssprays exterminators flea collars

Household dust (tracking in on shoes)Household dust (tracking in on shoes)

Public schools hospitals parks Public schools hospitals parks childcare facilitieschildcare facilities

Agricultural uses amp workersrsquo clothesAgricultural uses amp workersrsquo clothes

Non-organic foodsNon-organic foods

Breast milkBreast milk

Strategies to Reduces Strategies to Reduces Exposure to Home amp Garden Exposure to Home amp Garden

Pesticides in OregonPesticides in OregonPolicy SolutionsPolicy Solutions OR pesticide use reporting system OR pesticide use reporting system

(1999) finally funded 2005(1999) finally funded 2005 Educate homeowners re nontoxic Educate homeowners re nontoxic

options options Enc pet owners to use flea combs and Enc pet owners to use flea combs and

vacuuming to control fleasvacuuming to control fleas Enc public places to use Integrated Enc public places to use Integrated

Pest Management (IPM) ie Pesticide Pest Management (IPM) ie Pesticide Free ParksFree Parks

What YOU Can Do about What YOU Can Do about PesticidesPesticides

Advise PatientsAdvise Patients Regularly dustRegularly dust Use Integrated Pest Management Use Integrated Pest Management Cleanremove shoes outsideCleanremove shoes outside Keep contaminated clothes separateKeep contaminated clothes separate Buy sustainably grown foodBuy sustainably grown food Store food in secure nontoxic Store food in secure nontoxic

containerscontainers

Mercury amp Women of Mercury amp Women of Childbearing AgeChildbearing Age

A 32 yo G0P0 woman of A 32 yo G0P0 woman of childbearing age (WCBA) childbearing age (WCBA) presents for annual PE presents for annual PE

PMH negativePMH negative

Social hx husband is Social hx husband is recreational fisherman recreational fisherman

Contemplating pregnancy Contemplating pregnancy

Should she avoid fish Should she avoid fish because of mercury risks because of mercury risks to the fetusto the fetus

Mercury amp WCBAMercury amp WCBA

gt10gt10 of WCBA exceed safe limit of of WCBA exceed safe limit of 1ugkgday1ugkgday

5050 of women of women who eat fishwho eat fish exceed exceed limitlimit

5757 of WCBA have Hg levels of WCBA have Hg levels concerning for adverse effects concerning for adverse effects (CDC (CDC Natrsquol Report 0705Natrsquol Report 0705))

Higher risk Higher risk 300 000 childrenyear 300 000 childrenyear subsistence fishers immigrants subsistence fishers immigrants Native AmericansNative Americans

Mercury amp WCBAMercury amp WCBA

Hg enters tissues variable excretionHg enters tissues variable excretion Breast Milk PCBs DDT amp other Breast Milk PCBs DDT amp other

pesticides dioxins dibenzofurans pesticides dioxins dibenzofurans toxic flame retardants amp heavy toxic flame retardants amp heavy metals (Pb amp Hg) metals (Pb amp Hg)

No bio-accumulation in milk but No bio-accumulation in milk but levels in fish-eaters may exceed levels in fish-eaters may exceed unexposed women by 100x unexposed women by 100x

Scientific evidence indicates Scientific evidence indicates advantages of breast-feeding advantages of breast-feeding outweigh riskshellipoutweigh riskshellip

Neuro Effects of MercuryNeuro Effects of Mercury

Cerebral palsyCerebral palsy MRDDMRDD disequilibrium ataxiadisequilibrium ataxia hearing lossdeafnesshearing lossdeafness visual visual

impairmentblindnessimpairmentblindness peripheral neuropathyperipheral neuropathy parasthesiasparasthesias tremors seizures tremors seizures abnl reflexes amp muscle toneabnl reflexes amp muscle tone Psychiatric disturbances Psychiatric disturbances

Mercury a Persistent Mercury a Persistent ProblemProblem

PoisoningsPoisonings Minamata 1950s amp Iraq Minamata 1950s amp Iraq 19711971

Nationally ~Nationally ~160 tons of Hg annually160 tons of Hg annually In OregonIn Oregon ~ ~4500 lbs annually4500 lbs annually Lack of regulationLack of regulation In OR 10 facilities In OR 10 facilities

report Hg release-none has a permit or is report Hg release-none has a permit or is required to monitor emissions by staterequired to monitor emissions by state

Fish AdvisoriesFish Advisories in 2004 45 states had in 2004 45 states had gt2000 warnings Oregon lists advisories gt2000 warnings Oregon lists advisories for 12 water bodies inc Willamette for 12 water bodies inc Willamette

Atmospheric HgAtmospheric Hg

The Mercury CycleThe Mercury Cycle

MercuryMercuryDeclining Threshold of Declining Threshold of

HarmHarm

2000199019801970001

01

1

10

100

YEAR

Level associated with harmful effectRegulatory standard (maximum safe exposure or high end exposure from allowed fish contamination)

FDA WHO

EPA

ATSDR

DA

ILY

IN

TA

KE

(mic

rogr

ams

kg

day

Hg)

Sources of MercurySources of MercuryIndustrial emissions Industrial emissions

coal fired plantscoal fired plantsMunicipal amp medical Municipal amp medical

waste incineratorswaste incineratorsAbandoned Hg amp gold Abandoned Hg amp gold

minesminesNatural off-gassing Natural off-gassing Dental amalgamsDental amalgamsBioaccumulation in Bioaccumulation in

foods esp fishfoods esp fishOld thermometers BP Old thermometers BP

cuffs amp auto cuffs amp auto switchesswitches

Strategies to Reduce Strategies to Reduce Mercury Pollution in Mercury Pollution in

OregonOregonPolicy SolutionsPolicy Solutions Mercury Solutions Act of 2001Mercury Solutions Act of 2001 Ensure safe collection amp recyclingEnsure safe collection amp recycling Clean up abandoned mines and Clean up abandoned mines and

SuperfundsSuperfunds Reduce Hg emissions from health Reduce Hg emissions from health

care facilitiescare facilities Inc Hg in applicable DEQ air amp Inc Hg in applicable DEQ air amp

water permitswater permits Coal burning power plant Boardman Coal burning power plant Boardman

OR OR Implement OR Executive OrderImplement OR Executive Order

What YOU Can Do about What YOU Can Do about MercuryMercury

Advise PatientsAdvise Patients Provide Provide An Expectant Motherrsquos Guide to An Expectant Motherrsquos Guide to

Eating Fish in Oregon (DHS) Eating Fish in Oregon (DHS) in waiting in waiting roomsrooms

Rec WCBA and children avoid fish wHgRec WCBA and children avoid fish wHg Enc WCBA to consume low-fat dietEnc WCBA to consume low-fat diet Recycle old Hg thermometers Recycle old Hg thermometers

thermostats amp fluorescent light tubesthermostats amp fluorescent light tubes Have car checked for Hg switches at Have car checked for Hg switches at

participating auto shop (free participating auto shop (free replacement)replacement)

Use digital thermometers amp thermostatsUse digital thermometers amp thermostats

SummarySummary Chronic Diseases are prevalent Toxic Chronic Diseases are prevalent Toxic

exposures are possible exposures are possible preventablepreventable contributorscontributors

Pesticides amp risk of Parkinsonrsquos and Mercury Pesticides amp risk of Parkinsonrsquos and Mercury risks to WCBA are more understood than most risks to WCBA are more understood than most toxins and other chronic diseasestoxins and other chronic diseases

Apparent toxicity at high doses should be a Apparent toxicity at high doses should be a red flag for possible harm from low dose red flag for possible harm from low dose chronic exposureschronic exposures

Since ldquoproofrdquo of harm materializes slowly Since ldquoproofrdquo of harm materializes slowly generations are at risk and may be harmed generations are at risk and may be harmed before adequate regulatory response occursbefore adequate regulatory response occurs

Kaiser amp HCWHh2eKaiser amp HCWHh2e

Clean Diesel Hospital Zones ProjectClean Diesel Hospital Zones Project Healthy Food in Healthcare InitiativeHealthy Food in Healthcare Initiative Green Building PVC and DEHP free Green Building PVC and DEHP free

NICU NICU Environmentally preferable purchasing Environmentally preferable purchasing

policypolicy Making Medicine Mercury Free Award Making Medicine Mercury Free Award h2e Environmental Leadership Award h2e Environmental Leadership Award

20022002

What Can You DoWhat Can You Do

Be aware of environmental toxins amp Be aware of environmental toxins amp their possible links to chronic diseasestheir possible links to chronic diseases

Provide advice amp education on Provide advice amp education on prevention andor minimizing prevention andor minimizing exposures or refer appropriately exposures or refer appropriately

Incorporate environmental questions Incorporate environmental questions into clinical historyinto clinical history

Advocate Advocate wwwenvirohealthactionorgwwwenvirohealthactionorg

Local AdvocacyLocal Advocacy Oregon Environmental CouncilOregon Environmental Council wwwoeconlineorgwwwoeconlineorg Oregon Collaborative on Health amp Oregon Collaborative on Health amp

EnvironmentEnvironment Healthy Environment ForumsHealthy Environment Forums Oregon Center for Environmental HealthOregon Center for Environmental Health wwworegon-healthorgwwworegon-healthorg Healthcare without HarmHealthcare without Harm Hospitals for Healthy Environment (h2e)Hospitals for Healthy Environment (h2e) Oregon PSROregon PSR wwworegonpsrorgwwworegonpsrorg Environmental Health-In Harmrsquos Way Environmental Health-In Harmrsquos Way

Pesticides a Persistent Pesticides a Persistent ProblemProblem

Major classesMajor classes insecticides fungicides insecticides fungicides herbicides rodenticidesherbicides rodenticides

1997 Market1997 Market US $119 billion World $37 US $119 billion World $37 billionbillion

HistoryHistory synthetic-new to humans amp synthetic-new to humans amp environment since 1940s gt800 licensed environment since 1940s gt800 licensed ldquoactiverdquo ingredientsldquoactiverdquo ingredients

Manufacturers Manufacturers Bayer Aventis other drug Bayer Aventis other drug coco

Inherent toxicityInherent toxicity 140 pesticides considered 140 pesticides considered neurotoxic 37 are used on food ampor feedneurotoxic 37 are used on food ampor feed

Insecticide Sites of Insecticide Sites of ActionAction

Enzymes

Axonal Membranes

Ions (Na+ K+ Ca++ Cl-)

Enzymes

Neurotransmitters

Organochlorines

Pyrethroids

Casarett and Doullrsquos Toxicology The Basic Science of Poisons 5th Edition Ed Klaassen CD

McGraw-Hill New York 1996 P 649

Organophosphorus and

Carbamate Esters

Organophosphate PesticidesOrganophosphate PesticidesOccurrence and distribution in surface amp

ground water of the United States 1992-97

httpgawaterusgsgovpublicationsabstractsofr00-187html

Background Pesticide Background Pesticide Exposures WidespreadExposures Widespread

Reported useReported use 98 of families 80 during 98 of families 80 during pregnancypregnancy

In HumansIn Humans detectable chlorpyrifos detectable chlorpyrifos metabolites in 92 of childrenrsquos 82 of metabolites in 92 of childrenrsquos 82 of adultsrsquo urine samplesadultsrsquo urine samples

In FoodIn Food residues of at least one pesticide on residues of at least one pesticide on 72 fruits amp vegetables72 fruits amp vegetables

In HomesIn Homes 3 to 9 pesticide residues found3 to 9 pesticide residues found

In AirIn Air indoor levels 10-100X higher than indoor levels 10-100X higher than outdooroutdoor

In WaterIn Water gt90 stream samples 50 of gt90 stream samples 50 of wellswells

Sources of PesticidesSources of Pesticides

Household uses lawn amp garden Household uses lawn amp garden sprays exterminators flea collarssprays exterminators flea collars

Household dust (tracking in on shoes)Household dust (tracking in on shoes)

Public schools hospitals parks Public schools hospitals parks childcare facilitieschildcare facilities

Agricultural uses amp workersrsquo clothesAgricultural uses amp workersrsquo clothes

Non-organic foodsNon-organic foods

Breast milkBreast milk

Strategies to Reduces Strategies to Reduces Exposure to Home amp Garden Exposure to Home amp Garden

Pesticides in OregonPesticides in OregonPolicy SolutionsPolicy Solutions OR pesticide use reporting system OR pesticide use reporting system

(1999) finally funded 2005(1999) finally funded 2005 Educate homeowners re nontoxic Educate homeowners re nontoxic

options options Enc pet owners to use flea combs and Enc pet owners to use flea combs and

vacuuming to control fleasvacuuming to control fleas Enc public places to use Integrated Enc public places to use Integrated

Pest Management (IPM) ie Pesticide Pest Management (IPM) ie Pesticide Free ParksFree Parks

What YOU Can Do about What YOU Can Do about PesticidesPesticides

Advise PatientsAdvise Patients Regularly dustRegularly dust Use Integrated Pest Management Use Integrated Pest Management Cleanremove shoes outsideCleanremove shoes outside Keep contaminated clothes separateKeep contaminated clothes separate Buy sustainably grown foodBuy sustainably grown food Store food in secure nontoxic Store food in secure nontoxic

containerscontainers

Mercury amp Women of Mercury amp Women of Childbearing AgeChildbearing Age

A 32 yo G0P0 woman of A 32 yo G0P0 woman of childbearing age (WCBA) childbearing age (WCBA) presents for annual PE presents for annual PE

PMH negativePMH negative

Social hx husband is Social hx husband is recreational fisherman recreational fisherman

Contemplating pregnancy Contemplating pregnancy

Should she avoid fish Should she avoid fish because of mercury risks because of mercury risks to the fetusto the fetus

Mercury amp WCBAMercury amp WCBA

gt10gt10 of WCBA exceed safe limit of of WCBA exceed safe limit of 1ugkgday1ugkgday

5050 of women of women who eat fishwho eat fish exceed exceed limitlimit

5757 of WCBA have Hg levels of WCBA have Hg levels concerning for adverse effects concerning for adverse effects (CDC (CDC Natrsquol Report 0705Natrsquol Report 0705))

Higher risk Higher risk 300 000 childrenyear 300 000 childrenyear subsistence fishers immigrants subsistence fishers immigrants Native AmericansNative Americans

Mercury amp WCBAMercury amp WCBA

Hg enters tissues variable excretionHg enters tissues variable excretion Breast Milk PCBs DDT amp other Breast Milk PCBs DDT amp other

pesticides dioxins dibenzofurans pesticides dioxins dibenzofurans toxic flame retardants amp heavy toxic flame retardants amp heavy metals (Pb amp Hg) metals (Pb amp Hg)

No bio-accumulation in milk but No bio-accumulation in milk but levels in fish-eaters may exceed levels in fish-eaters may exceed unexposed women by 100x unexposed women by 100x

Scientific evidence indicates Scientific evidence indicates advantages of breast-feeding advantages of breast-feeding outweigh riskshellipoutweigh riskshellip

Neuro Effects of MercuryNeuro Effects of Mercury

Cerebral palsyCerebral palsy MRDDMRDD disequilibrium ataxiadisequilibrium ataxia hearing lossdeafnesshearing lossdeafness visual visual

impairmentblindnessimpairmentblindness peripheral neuropathyperipheral neuropathy parasthesiasparasthesias tremors seizures tremors seizures abnl reflexes amp muscle toneabnl reflexes amp muscle tone Psychiatric disturbances Psychiatric disturbances

Mercury a Persistent Mercury a Persistent ProblemProblem

PoisoningsPoisonings Minamata 1950s amp Iraq Minamata 1950s amp Iraq 19711971

Nationally ~Nationally ~160 tons of Hg annually160 tons of Hg annually In OregonIn Oregon ~ ~4500 lbs annually4500 lbs annually Lack of regulationLack of regulation In OR 10 facilities In OR 10 facilities

report Hg release-none has a permit or is report Hg release-none has a permit or is required to monitor emissions by staterequired to monitor emissions by state

Fish AdvisoriesFish Advisories in 2004 45 states had in 2004 45 states had gt2000 warnings Oregon lists advisories gt2000 warnings Oregon lists advisories for 12 water bodies inc Willamette for 12 water bodies inc Willamette

Atmospheric HgAtmospheric Hg

The Mercury CycleThe Mercury Cycle

MercuryMercuryDeclining Threshold of Declining Threshold of

HarmHarm

2000199019801970001

01

1

10

100

YEAR

Level associated with harmful effectRegulatory standard (maximum safe exposure or high end exposure from allowed fish contamination)

FDA WHO

EPA

ATSDR

DA

ILY

IN

TA

KE

(mic

rogr

ams

kg

day

Hg)

Sources of MercurySources of MercuryIndustrial emissions Industrial emissions

coal fired plantscoal fired plantsMunicipal amp medical Municipal amp medical

waste incineratorswaste incineratorsAbandoned Hg amp gold Abandoned Hg amp gold

minesminesNatural off-gassing Natural off-gassing Dental amalgamsDental amalgamsBioaccumulation in Bioaccumulation in

foods esp fishfoods esp fishOld thermometers BP Old thermometers BP

cuffs amp auto cuffs amp auto switchesswitches

Strategies to Reduce Strategies to Reduce Mercury Pollution in Mercury Pollution in

OregonOregonPolicy SolutionsPolicy Solutions Mercury Solutions Act of 2001Mercury Solutions Act of 2001 Ensure safe collection amp recyclingEnsure safe collection amp recycling Clean up abandoned mines and Clean up abandoned mines and

SuperfundsSuperfunds Reduce Hg emissions from health Reduce Hg emissions from health

care facilitiescare facilities Inc Hg in applicable DEQ air amp Inc Hg in applicable DEQ air amp

water permitswater permits Coal burning power plant Boardman Coal burning power plant Boardman

OR OR Implement OR Executive OrderImplement OR Executive Order

What YOU Can Do about What YOU Can Do about MercuryMercury

Advise PatientsAdvise Patients Provide Provide An Expectant Motherrsquos Guide to An Expectant Motherrsquos Guide to

Eating Fish in Oregon (DHS) Eating Fish in Oregon (DHS) in waiting in waiting roomsrooms

Rec WCBA and children avoid fish wHgRec WCBA and children avoid fish wHg Enc WCBA to consume low-fat dietEnc WCBA to consume low-fat diet Recycle old Hg thermometers Recycle old Hg thermometers

thermostats amp fluorescent light tubesthermostats amp fluorescent light tubes Have car checked for Hg switches at Have car checked for Hg switches at

participating auto shop (free participating auto shop (free replacement)replacement)

Use digital thermometers amp thermostatsUse digital thermometers amp thermostats

SummarySummary Chronic Diseases are prevalent Toxic Chronic Diseases are prevalent Toxic

exposures are possible exposures are possible preventablepreventable contributorscontributors

Pesticides amp risk of Parkinsonrsquos and Mercury Pesticides amp risk of Parkinsonrsquos and Mercury risks to WCBA are more understood than most risks to WCBA are more understood than most toxins and other chronic diseasestoxins and other chronic diseases

Apparent toxicity at high doses should be a Apparent toxicity at high doses should be a red flag for possible harm from low dose red flag for possible harm from low dose chronic exposureschronic exposures

Since ldquoproofrdquo of harm materializes slowly Since ldquoproofrdquo of harm materializes slowly generations are at risk and may be harmed generations are at risk and may be harmed before adequate regulatory response occursbefore adequate regulatory response occurs

Kaiser amp HCWHh2eKaiser amp HCWHh2e

Clean Diesel Hospital Zones ProjectClean Diesel Hospital Zones Project Healthy Food in Healthcare InitiativeHealthy Food in Healthcare Initiative Green Building PVC and DEHP free Green Building PVC and DEHP free

NICU NICU Environmentally preferable purchasing Environmentally preferable purchasing

policypolicy Making Medicine Mercury Free Award Making Medicine Mercury Free Award h2e Environmental Leadership Award h2e Environmental Leadership Award

20022002

What Can You DoWhat Can You Do

Be aware of environmental toxins amp Be aware of environmental toxins amp their possible links to chronic diseasestheir possible links to chronic diseases

Provide advice amp education on Provide advice amp education on prevention andor minimizing prevention andor minimizing exposures or refer appropriately exposures or refer appropriately

Incorporate environmental questions Incorporate environmental questions into clinical historyinto clinical history

Advocate Advocate wwwenvirohealthactionorgwwwenvirohealthactionorg

Local AdvocacyLocal Advocacy Oregon Environmental CouncilOregon Environmental Council wwwoeconlineorgwwwoeconlineorg Oregon Collaborative on Health amp Oregon Collaborative on Health amp

EnvironmentEnvironment Healthy Environment ForumsHealthy Environment Forums Oregon Center for Environmental HealthOregon Center for Environmental Health wwworegon-healthorgwwworegon-healthorg Healthcare without HarmHealthcare without Harm Hospitals for Healthy Environment (h2e)Hospitals for Healthy Environment (h2e) Oregon PSROregon PSR wwworegonpsrorgwwworegonpsrorg Environmental Health-In Harmrsquos Way Environmental Health-In Harmrsquos Way

Insecticide Sites of Insecticide Sites of ActionAction

Enzymes

Axonal Membranes

Ions (Na+ K+ Ca++ Cl-)

Enzymes

Neurotransmitters

Organochlorines

Pyrethroids

Casarett and Doullrsquos Toxicology The Basic Science of Poisons 5th Edition Ed Klaassen CD

McGraw-Hill New York 1996 P 649

Organophosphorus and

Carbamate Esters

Organophosphate PesticidesOrganophosphate PesticidesOccurrence and distribution in surface amp

ground water of the United States 1992-97

httpgawaterusgsgovpublicationsabstractsofr00-187html

Background Pesticide Background Pesticide Exposures WidespreadExposures Widespread

Reported useReported use 98 of families 80 during 98 of families 80 during pregnancypregnancy

In HumansIn Humans detectable chlorpyrifos detectable chlorpyrifos metabolites in 92 of childrenrsquos 82 of metabolites in 92 of childrenrsquos 82 of adultsrsquo urine samplesadultsrsquo urine samples

In FoodIn Food residues of at least one pesticide on residues of at least one pesticide on 72 fruits amp vegetables72 fruits amp vegetables

In HomesIn Homes 3 to 9 pesticide residues found3 to 9 pesticide residues found

In AirIn Air indoor levels 10-100X higher than indoor levels 10-100X higher than outdooroutdoor

In WaterIn Water gt90 stream samples 50 of gt90 stream samples 50 of wellswells

Sources of PesticidesSources of Pesticides

Household uses lawn amp garden Household uses lawn amp garden sprays exterminators flea collarssprays exterminators flea collars

Household dust (tracking in on shoes)Household dust (tracking in on shoes)

Public schools hospitals parks Public schools hospitals parks childcare facilitieschildcare facilities

Agricultural uses amp workersrsquo clothesAgricultural uses amp workersrsquo clothes

Non-organic foodsNon-organic foods

Breast milkBreast milk

Strategies to Reduces Strategies to Reduces Exposure to Home amp Garden Exposure to Home amp Garden

Pesticides in OregonPesticides in OregonPolicy SolutionsPolicy Solutions OR pesticide use reporting system OR pesticide use reporting system

(1999) finally funded 2005(1999) finally funded 2005 Educate homeowners re nontoxic Educate homeowners re nontoxic

options options Enc pet owners to use flea combs and Enc pet owners to use flea combs and

vacuuming to control fleasvacuuming to control fleas Enc public places to use Integrated Enc public places to use Integrated

Pest Management (IPM) ie Pesticide Pest Management (IPM) ie Pesticide Free ParksFree Parks

What YOU Can Do about What YOU Can Do about PesticidesPesticides

Advise PatientsAdvise Patients Regularly dustRegularly dust Use Integrated Pest Management Use Integrated Pest Management Cleanremove shoes outsideCleanremove shoes outside Keep contaminated clothes separateKeep contaminated clothes separate Buy sustainably grown foodBuy sustainably grown food Store food in secure nontoxic Store food in secure nontoxic

containerscontainers

Mercury amp Women of Mercury amp Women of Childbearing AgeChildbearing Age

A 32 yo G0P0 woman of A 32 yo G0P0 woman of childbearing age (WCBA) childbearing age (WCBA) presents for annual PE presents for annual PE

PMH negativePMH negative

Social hx husband is Social hx husband is recreational fisherman recreational fisherman

Contemplating pregnancy Contemplating pregnancy

Should she avoid fish Should she avoid fish because of mercury risks because of mercury risks to the fetusto the fetus

Mercury amp WCBAMercury amp WCBA

gt10gt10 of WCBA exceed safe limit of of WCBA exceed safe limit of 1ugkgday1ugkgday

5050 of women of women who eat fishwho eat fish exceed exceed limitlimit

5757 of WCBA have Hg levels of WCBA have Hg levels concerning for adverse effects concerning for adverse effects (CDC (CDC Natrsquol Report 0705Natrsquol Report 0705))

Higher risk Higher risk 300 000 childrenyear 300 000 childrenyear subsistence fishers immigrants subsistence fishers immigrants Native AmericansNative Americans

Mercury amp WCBAMercury amp WCBA

Hg enters tissues variable excretionHg enters tissues variable excretion Breast Milk PCBs DDT amp other Breast Milk PCBs DDT amp other

pesticides dioxins dibenzofurans pesticides dioxins dibenzofurans toxic flame retardants amp heavy toxic flame retardants amp heavy metals (Pb amp Hg) metals (Pb amp Hg)

No bio-accumulation in milk but No bio-accumulation in milk but levels in fish-eaters may exceed levels in fish-eaters may exceed unexposed women by 100x unexposed women by 100x

Scientific evidence indicates Scientific evidence indicates advantages of breast-feeding advantages of breast-feeding outweigh riskshellipoutweigh riskshellip

Neuro Effects of MercuryNeuro Effects of Mercury

Cerebral palsyCerebral palsy MRDDMRDD disequilibrium ataxiadisequilibrium ataxia hearing lossdeafnesshearing lossdeafness visual visual

impairmentblindnessimpairmentblindness peripheral neuropathyperipheral neuropathy parasthesiasparasthesias tremors seizures tremors seizures abnl reflexes amp muscle toneabnl reflexes amp muscle tone Psychiatric disturbances Psychiatric disturbances

Mercury a Persistent Mercury a Persistent ProblemProblem

PoisoningsPoisonings Minamata 1950s amp Iraq Minamata 1950s amp Iraq 19711971

Nationally ~Nationally ~160 tons of Hg annually160 tons of Hg annually In OregonIn Oregon ~ ~4500 lbs annually4500 lbs annually Lack of regulationLack of regulation In OR 10 facilities In OR 10 facilities

report Hg release-none has a permit or is report Hg release-none has a permit or is required to monitor emissions by staterequired to monitor emissions by state

Fish AdvisoriesFish Advisories in 2004 45 states had in 2004 45 states had gt2000 warnings Oregon lists advisories gt2000 warnings Oregon lists advisories for 12 water bodies inc Willamette for 12 water bodies inc Willamette

Atmospheric HgAtmospheric Hg

The Mercury CycleThe Mercury Cycle

MercuryMercuryDeclining Threshold of Declining Threshold of

HarmHarm

2000199019801970001

01

1

10

100

YEAR

Level associated with harmful effectRegulatory standard (maximum safe exposure or high end exposure from allowed fish contamination)

FDA WHO

EPA

ATSDR

DA

ILY

IN

TA

KE

(mic

rogr

ams

kg

day

Hg)

Sources of MercurySources of MercuryIndustrial emissions Industrial emissions

coal fired plantscoal fired plantsMunicipal amp medical Municipal amp medical

waste incineratorswaste incineratorsAbandoned Hg amp gold Abandoned Hg amp gold

minesminesNatural off-gassing Natural off-gassing Dental amalgamsDental amalgamsBioaccumulation in Bioaccumulation in

foods esp fishfoods esp fishOld thermometers BP Old thermometers BP

cuffs amp auto cuffs amp auto switchesswitches

Strategies to Reduce Strategies to Reduce Mercury Pollution in Mercury Pollution in

OregonOregonPolicy SolutionsPolicy Solutions Mercury Solutions Act of 2001Mercury Solutions Act of 2001 Ensure safe collection amp recyclingEnsure safe collection amp recycling Clean up abandoned mines and Clean up abandoned mines and

SuperfundsSuperfunds Reduce Hg emissions from health Reduce Hg emissions from health

care facilitiescare facilities Inc Hg in applicable DEQ air amp Inc Hg in applicable DEQ air amp

water permitswater permits Coal burning power plant Boardman Coal burning power plant Boardman

OR OR Implement OR Executive OrderImplement OR Executive Order

What YOU Can Do about What YOU Can Do about MercuryMercury

Advise PatientsAdvise Patients Provide Provide An Expectant Motherrsquos Guide to An Expectant Motherrsquos Guide to

Eating Fish in Oregon (DHS) Eating Fish in Oregon (DHS) in waiting in waiting roomsrooms

Rec WCBA and children avoid fish wHgRec WCBA and children avoid fish wHg Enc WCBA to consume low-fat dietEnc WCBA to consume low-fat diet Recycle old Hg thermometers Recycle old Hg thermometers

thermostats amp fluorescent light tubesthermostats amp fluorescent light tubes Have car checked for Hg switches at Have car checked for Hg switches at

participating auto shop (free participating auto shop (free replacement)replacement)

Use digital thermometers amp thermostatsUse digital thermometers amp thermostats

SummarySummary Chronic Diseases are prevalent Toxic Chronic Diseases are prevalent Toxic

exposures are possible exposures are possible preventablepreventable contributorscontributors

Pesticides amp risk of Parkinsonrsquos and Mercury Pesticides amp risk of Parkinsonrsquos and Mercury risks to WCBA are more understood than most risks to WCBA are more understood than most toxins and other chronic diseasestoxins and other chronic diseases

Apparent toxicity at high doses should be a Apparent toxicity at high doses should be a red flag for possible harm from low dose red flag for possible harm from low dose chronic exposureschronic exposures

Since ldquoproofrdquo of harm materializes slowly Since ldquoproofrdquo of harm materializes slowly generations are at risk and may be harmed generations are at risk and may be harmed before adequate regulatory response occursbefore adequate regulatory response occurs

Kaiser amp HCWHh2eKaiser amp HCWHh2e

Clean Diesel Hospital Zones ProjectClean Diesel Hospital Zones Project Healthy Food in Healthcare InitiativeHealthy Food in Healthcare Initiative Green Building PVC and DEHP free Green Building PVC and DEHP free

NICU NICU Environmentally preferable purchasing Environmentally preferable purchasing

policypolicy Making Medicine Mercury Free Award Making Medicine Mercury Free Award h2e Environmental Leadership Award h2e Environmental Leadership Award

20022002

What Can You DoWhat Can You Do

Be aware of environmental toxins amp Be aware of environmental toxins amp their possible links to chronic diseasestheir possible links to chronic diseases

Provide advice amp education on Provide advice amp education on prevention andor minimizing prevention andor minimizing exposures or refer appropriately exposures or refer appropriately

Incorporate environmental questions Incorporate environmental questions into clinical historyinto clinical history

Advocate Advocate wwwenvirohealthactionorgwwwenvirohealthactionorg

Local AdvocacyLocal Advocacy Oregon Environmental CouncilOregon Environmental Council wwwoeconlineorgwwwoeconlineorg Oregon Collaborative on Health amp Oregon Collaborative on Health amp

EnvironmentEnvironment Healthy Environment ForumsHealthy Environment Forums Oregon Center for Environmental HealthOregon Center for Environmental Health wwworegon-healthorgwwworegon-healthorg Healthcare without HarmHealthcare without Harm Hospitals for Healthy Environment (h2e)Hospitals for Healthy Environment (h2e) Oregon PSROregon PSR wwworegonpsrorgwwworegonpsrorg Environmental Health-In Harmrsquos Way Environmental Health-In Harmrsquos Way

Organophosphate PesticidesOrganophosphate PesticidesOccurrence and distribution in surface amp

ground water of the United States 1992-97

httpgawaterusgsgovpublicationsabstractsofr00-187html

Background Pesticide Background Pesticide Exposures WidespreadExposures Widespread

Reported useReported use 98 of families 80 during 98 of families 80 during pregnancypregnancy

In HumansIn Humans detectable chlorpyrifos detectable chlorpyrifos metabolites in 92 of childrenrsquos 82 of metabolites in 92 of childrenrsquos 82 of adultsrsquo urine samplesadultsrsquo urine samples

In FoodIn Food residues of at least one pesticide on residues of at least one pesticide on 72 fruits amp vegetables72 fruits amp vegetables

In HomesIn Homes 3 to 9 pesticide residues found3 to 9 pesticide residues found

In AirIn Air indoor levels 10-100X higher than indoor levels 10-100X higher than outdooroutdoor

In WaterIn Water gt90 stream samples 50 of gt90 stream samples 50 of wellswells

Sources of PesticidesSources of Pesticides

Household uses lawn amp garden Household uses lawn amp garden sprays exterminators flea collarssprays exterminators flea collars

Household dust (tracking in on shoes)Household dust (tracking in on shoes)

Public schools hospitals parks Public schools hospitals parks childcare facilitieschildcare facilities

Agricultural uses amp workersrsquo clothesAgricultural uses amp workersrsquo clothes

Non-organic foodsNon-organic foods

Breast milkBreast milk

Strategies to Reduces Strategies to Reduces Exposure to Home amp Garden Exposure to Home amp Garden

Pesticides in OregonPesticides in OregonPolicy SolutionsPolicy Solutions OR pesticide use reporting system OR pesticide use reporting system

(1999) finally funded 2005(1999) finally funded 2005 Educate homeowners re nontoxic Educate homeowners re nontoxic

options options Enc pet owners to use flea combs and Enc pet owners to use flea combs and

vacuuming to control fleasvacuuming to control fleas Enc public places to use Integrated Enc public places to use Integrated

Pest Management (IPM) ie Pesticide Pest Management (IPM) ie Pesticide Free ParksFree Parks

What YOU Can Do about What YOU Can Do about PesticidesPesticides

Advise PatientsAdvise Patients Regularly dustRegularly dust Use Integrated Pest Management Use Integrated Pest Management Cleanremove shoes outsideCleanremove shoes outside Keep contaminated clothes separateKeep contaminated clothes separate Buy sustainably grown foodBuy sustainably grown food Store food in secure nontoxic Store food in secure nontoxic

containerscontainers

Mercury amp Women of Mercury amp Women of Childbearing AgeChildbearing Age

A 32 yo G0P0 woman of A 32 yo G0P0 woman of childbearing age (WCBA) childbearing age (WCBA) presents for annual PE presents for annual PE

PMH negativePMH negative

Social hx husband is Social hx husband is recreational fisherman recreational fisherman

Contemplating pregnancy Contemplating pregnancy

Should she avoid fish Should she avoid fish because of mercury risks because of mercury risks to the fetusto the fetus

Mercury amp WCBAMercury amp WCBA

gt10gt10 of WCBA exceed safe limit of of WCBA exceed safe limit of 1ugkgday1ugkgday

5050 of women of women who eat fishwho eat fish exceed exceed limitlimit

5757 of WCBA have Hg levels of WCBA have Hg levels concerning for adverse effects concerning for adverse effects (CDC (CDC Natrsquol Report 0705Natrsquol Report 0705))

Higher risk Higher risk 300 000 childrenyear 300 000 childrenyear subsistence fishers immigrants subsistence fishers immigrants Native AmericansNative Americans

Mercury amp WCBAMercury amp WCBA

Hg enters tissues variable excretionHg enters tissues variable excretion Breast Milk PCBs DDT amp other Breast Milk PCBs DDT amp other

pesticides dioxins dibenzofurans pesticides dioxins dibenzofurans toxic flame retardants amp heavy toxic flame retardants amp heavy metals (Pb amp Hg) metals (Pb amp Hg)

No bio-accumulation in milk but No bio-accumulation in milk but levels in fish-eaters may exceed levels in fish-eaters may exceed unexposed women by 100x unexposed women by 100x

Scientific evidence indicates Scientific evidence indicates advantages of breast-feeding advantages of breast-feeding outweigh riskshellipoutweigh riskshellip

Neuro Effects of MercuryNeuro Effects of Mercury

Cerebral palsyCerebral palsy MRDDMRDD disequilibrium ataxiadisequilibrium ataxia hearing lossdeafnesshearing lossdeafness visual visual

impairmentblindnessimpairmentblindness peripheral neuropathyperipheral neuropathy parasthesiasparasthesias tremors seizures tremors seizures abnl reflexes amp muscle toneabnl reflexes amp muscle tone Psychiatric disturbances Psychiatric disturbances

Mercury a Persistent Mercury a Persistent ProblemProblem

PoisoningsPoisonings Minamata 1950s amp Iraq Minamata 1950s amp Iraq 19711971

Nationally ~Nationally ~160 tons of Hg annually160 tons of Hg annually In OregonIn Oregon ~ ~4500 lbs annually4500 lbs annually Lack of regulationLack of regulation In OR 10 facilities In OR 10 facilities

report Hg release-none has a permit or is report Hg release-none has a permit or is required to monitor emissions by staterequired to monitor emissions by state

Fish AdvisoriesFish Advisories in 2004 45 states had in 2004 45 states had gt2000 warnings Oregon lists advisories gt2000 warnings Oregon lists advisories for 12 water bodies inc Willamette for 12 water bodies inc Willamette

Atmospheric HgAtmospheric Hg

The Mercury CycleThe Mercury Cycle

MercuryMercuryDeclining Threshold of Declining Threshold of

HarmHarm

2000199019801970001

01

1

10

100

YEAR

Level associated with harmful effectRegulatory standard (maximum safe exposure or high end exposure from allowed fish contamination)

FDA WHO

EPA

ATSDR

DA

ILY

IN

TA

KE

(mic

rogr

ams

kg

day

Hg)

Sources of MercurySources of MercuryIndustrial emissions Industrial emissions

coal fired plantscoal fired plantsMunicipal amp medical Municipal amp medical

waste incineratorswaste incineratorsAbandoned Hg amp gold Abandoned Hg amp gold

minesminesNatural off-gassing Natural off-gassing Dental amalgamsDental amalgamsBioaccumulation in Bioaccumulation in

foods esp fishfoods esp fishOld thermometers BP Old thermometers BP

cuffs amp auto cuffs amp auto switchesswitches

Strategies to Reduce Strategies to Reduce Mercury Pollution in Mercury Pollution in

OregonOregonPolicy SolutionsPolicy Solutions Mercury Solutions Act of 2001Mercury Solutions Act of 2001 Ensure safe collection amp recyclingEnsure safe collection amp recycling Clean up abandoned mines and Clean up abandoned mines and

SuperfundsSuperfunds Reduce Hg emissions from health Reduce Hg emissions from health

care facilitiescare facilities Inc Hg in applicable DEQ air amp Inc Hg in applicable DEQ air amp

water permitswater permits Coal burning power plant Boardman Coal burning power plant Boardman

OR OR Implement OR Executive OrderImplement OR Executive Order

What YOU Can Do about What YOU Can Do about MercuryMercury

Advise PatientsAdvise Patients Provide Provide An Expectant Motherrsquos Guide to An Expectant Motherrsquos Guide to

Eating Fish in Oregon (DHS) Eating Fish in Oregon (DHS) in waiting in waiting roomsrooms

Rec WCBA and children avoid fish wHgRec WCBA and children avoid fish wHg Enc WCBA to consume low-fat dietEnc WCBA to consume low-fat diet Recycle old Hg thermometers Recycle old Hg thermometers

thermostats amp fluorescent light tubesthermostats amp fluorescent light tubes Have car checked for Hg switches at Have car checked for Hg switches at

participating auto shop (free participating auto shop (free replacement)replacement)

Use digital thermometers amp thermostatsUse digital thermometers amp thermostats

SummarySummary Chronic Diseases are prevalent Toxic Chronic Diseases are prevalent Toxic

exposures are possible exposures are possible preventablepreventable contributorscontributors

Pesticides amp risk of Parkinsonrsquos and Mercury Pesticides amp risk of Parkinsonrsquos and Mercury risks to WCBA are more understood than most risks to WCBA are more understood than most toxins and other chronic diseasestoxins and other chronic diseases

Apparent toxicity at high doses should be a Apparent toxicity at high doses should be a red flag for possible harm from low dose red flag for possible harm from low dose chronic exposureschronic exposures

Since ldquoproofrdquo of harm materializes slowly Since ldquoproofrdquo of harm materializes slowly generations are at risk and may be harmed generations are at risk and may be harmed before adequate regulatory response occursbefore adequate regulatory response occurs

Kaiser amp HCWHh2eKaiser amp HCWHh2e

Clean Diesel Hospital Zones ProjectClean Diesel Hospital Zones Project Healthy Food in Healthcare InitiativeHealthy Food in Healthcare Initiative Green Building PVC and DEHP free Green Building PVC and DEHP free

NICU NICU Environmentally preferable purchasing Environmentally preferable purchasing

policypolicy Making Medicine Mercury Free Award Making Medicine Mercury Free Award h2e Environmental Leadership Award h2e Environmental Leadership Award

20022002

What Can You DoWhat Can You Do

Be aware of environmental toxins amp Be aware of environmental toxins amp their possible links to chronic diseasestheir possible links to chronic diseases

Provide advice amp education on Provide advice amp education on prevention andor minimizing prevention andor minimizing exposures or refer appropriately exposures or refer appropriately

Incorporate environmental questions Incorporate environmental questions into clinical historyinto clinical history

Advocate Advocate wwwenvirohealthactionorgwwwenvirohealthactionorg

Local AdvocacyLocal Advocacy Oregon Environmental CouncilOregon Environmental Council wwwoeconlineorgwwwoeconlineorg Oregon Collaborative on Health amp Oregon Collaborative on Health amp

EnvironmentEnvironment Healthy Environment ForumsHealthy Environment Forums Oregon Center for Environmental HealthOregon Center for Environmental Health wwworegon-healthorgwwworegon-healthorg Healthcare without HarmHealthcare without Harm Hospitals for Healthy Environment (h2e)Hospitals for Healthy Environment (h2e) Oregon PSROregon PSR wwworegonpsrorgwwworegonpsrorg Environmental Health-In Harmrsquos Way Environmental Health-In Harmrsquos Way

Background Pesticide Background Pesticide Exposures WidespreadExposures Widespread

Reported useReported use 98 of families 80 during 98 of families 80 during pregnancypregnancy

In HumansIn Humans detectable chlorpyrifos detectable chlorpyrifos metabolites in 92 of childrenrsquos 82 of metabolites in 92 of childrenrsquos 82 of adultsrsquo urine samplesadultsrsquo urine samples

In FoodIn Food residues of at least one pesticide on residues of at least one pesticide on 72 fruits amp vegetables72 fruits amp vegetables

In HomesIn Homes 3 to 9 pesticide residues found3 to 9 pesticide residues found

In AirIn Air indoor levels 10-100X higher than indoor levels 10-100X higher than outdooroutdoor

In WaterIn Water gt90 stream samples 50 of gt90 stream samples 50 of wellswells

Sources of PesticidesSources of Pesticides

Household uses lawn amp garden Household uses lawn amp garden sprays exterminators flea collarssprays exterminators flea collars

Household dust (tracking in on shoes)Household dust (tracking in on shoes)

Public schools hospitals parks Public schools hospitals parks childcare facilitieschildcare facilities

Agricultural uses amp workersrsquo clothesAgricultural uses amp workersrsquo clothes

Non-organic foodsNon-organic foods

Breast milkBreast milk

Strategies to Reduces Strategies to Reduces Exposure to Home amp Garden Exposure to Home amp Garden

Pesticides in OregonPesticides in OregonPolicy SolutionsPolicy Solutions OR pesticide use reporting system OR pesticide use reporting system

(1999) finally funded 2005(1999) finally funded 2005 Educate homeowners re nontoxic Educate homeowners re nontoxic

options options Enc pet owners to use flea combs and Enc pet owners to use flea combs and

vacuuming to control fleasvacuuming to control fleas Enc public places to use Integrated Enc public places to use Integrated

Pest Management (IPM) ie Pesticide Pest Management (IPM) ie Pesticide Free ParksFree Parks

What YOU Can Do about What YOU Can Do about PesticidesPesticides

Advise PatientsAdvise Patients Regularly dustRegularly dust Use Integrated Pest Management Use Integrated Pest Management Cleanremove shoes outsideCleanremove shoes outside Keep contaminated clothes separateKeep contaminated clothes separate Buy sustainably grown foodBuy sustainably grown food Store food in secure nontoxic Store food in secure nontoxic

containerscontainers

Mercury amp Women of Mercury amp Women of Childbearing AgeChildbearing Age

A 32 yo G0P0 woman of A 32 yo G0P0 woman of childbearing age (WCBA) childbearing age (WCBA) presents for annual PE presents for annual PE

PMH negativePMH negative

Social hx husband is Social hx husband is recreational fisherman recreational fisherman

Contemplating pregnancy Contemplating pregnancy

Should she avoid fish Should she avoid fish because of mercury risks because of mercury risks to the fetusto the fetus

Mercury amp WCBAMercury amp WCBA

gt10gt10 of WCBA exceed safe limit of of WCBA exceed safe limit of 1ugkgday1ugkgday

5050 of women of women who eat fishwho eat fish exceed exceed limitlimit

5757 of WCBA have Hg levels of WCBA have Hg levels concerning for adverse effects concerning for adverse effects (CDC (CDC Natrsquol Report 0705Natrsquol Report 0705))

Higher risk Higher risk 300 000 childrenyear 300 000 childrenyear subsistence fishers immigrants subsistence fishers immigrants Native AmericansNative Americans

Mercury amp WCBAMercury amp WCBA

Hg enters tissues variable excretionHg enters tissues variable excretion Breast Milk PCBs DDT amp other Breast Milk PCBs DDT amp other

pesticides dioxins dibenzofurans pesticides dioxins dibenzofurans toxic flame retardants amp heavy toxic flame retardants amp heavy metals (Pb amp Hg) metals (Pb amp Hg)

No bio-accumulation in milk but No bio-accumulation in milk but levels in fish-eaters may exceed levels in fish-eaters may exceed unexposed women by 100x unexposed women by 100x

Scientific evidence indicates Scientific evidence indicates advantages of breast-feeding advantages of breast-feeding outweigh riskshellipoutweigh riskshellip

Neuro Effects of MercuryNeuro Effects of Mercury

Cerebral palsyCerebral palsy MRDDMRDD disequilibrium ataxiadisequilibrium ataxia hearing lossdeafnesshearing lossdeafness visual visual

impairmentblindnessimpairmentblindness peripheral neuropathyperipheral neuropathy parasthesiasparasthesias tremors seizures tremors seizures abnl reflexes amp muscle toneabnl reflexes amp muscle tone Psychiatric disturbances Psychiatric disturbances

Mercury a Persistent Mercury a Persistent ProblemProblem

PoisoningsPoisonings Minamata 1950s amp Iraq Minamata 1950s amp Iraq 19711971

Nationally ~Nationally ~160 tons of Hg annually160 tons of Hg annually In OregonIn Oregon ~ ~4500 lbs annually4500 lbs annually Lack of regulationLack of regulation In OR 10 facilities In OR 10 facilities

report Hg release-none has a permit or is report Hg release-none has a permit or is required to monitor emissions by staterequired to monitor emissions by state

Fish AdvisoriesFish Advisories in 2004 45 states had in 2004 45 states had gt2000 warnings Oregon lists advisories gt2000 warnings Oregon lists advisories for 12 water bodies inc Willamette for 12 water bodies inc Willamette

Atmospheric HgAtmospheric Hg

The Mercury CycleThe Mercury Cycle

MercuryMercuryDeclining Threshold of Declining Threshold of

HarmHarm

2000199019801970001

01

1

10

100

YEAR

Level associated with harmful effectRegulatory standard (maximum safe exposure or high end exposure from allowed fish contamination)

FDA WHO

EPA

ATSDR

DA

ILY

IN

TA

KE

(mic

rogr

ams

kg

day

Hg)

Sources of MercurySources of MercuryIndustrial emissions Industrial emissions

coal fired plantscoal fired plantsMunicipal amp medical Municipal amp medical

waste incineratorswaste incineratorsAbandoned Hg amp gold Abandoned Hg amp gold

minesminesNatural off-gassing Natural off-gassing Dental amalgamsDental amalgamsBioaccumulation in Bioaccumulation in

foods esp fishfoods esp fishOld thermometers BP Old thermometers BP

cuffs amp auto cuffs amp auto switchesswitches

Strategies to Reduce Strategies to Reduce Mercury Pollution in Mercury Pollution in

OregonOregonPolicy SolutionsPolicy Solutions Mercury Solutions Act of 2001Mercury Solutions Act of 2001 Ensure safe collection amp recyclingEnsure safe collection amp recycling Clean up abandoned mines and Clean up abandoned mines and

SuperfundsSuperfunds Reduce Hg emissions from health Reduce Hg emissions from health

care facilitiescare facilities Inc Hg in applicable DEQ air amp Inc Hg in applicable DEQ air amp

water permitswater permits Coal burning power plant Boardman Coal burning power plant Boardman

OR OR Implement OR Executive OrderImplement OR Executive Order

What YOU Can Do about What YOU Can Do about MercuryMercury

Advise PatientsAdvise Patients Provide Provide An Expectant Motherrsquos Guide to An Expectant Motherrsquos Guide to

Eating Fish in Oregon (DHS) Eating Fish in Oregon (DHS) in waiting in waiting roomsrooms

Rec WCBA and children avoid fish wHgRec WCBA and children avoid fish wHg Enc WCBA to consume low-fat dietEnc WCBA to consume low-fat diet Recycle old Hg thermometers Recycle old Hg thermometers

thermostats amp fluorescent light tubesthermostats amp fluorescent light tubes Have car checked for Hg switches at Have car checked for Hg switches at

participating auto shop (free participating auto shop (free replacement)replacement)

Use digital thermometers amp thermostatsUse digital thermometers amp thermostats

SummarySummary Chronic Diseases are prevalent Toxic Chronic Diseases are prevalent Toxic

exposures are possible exposures are possible preventablepreventable contributorscontributors

Pesticides amp risk of Parkinsonrsquos and Mercury Pesticides amp risk of Parkinsonrsquos and Mercury risks to WCBA are more understood than most risks to WCBA are more understood than most toxins and other chronic diseasestoxins and other chronic diseases

Apparent toxicity at high doses should be a Apparent toxicity at high doses should be a red flag for possible harm from low dose red flag for possible harm from low dose chronic exposureschronic exposures

Since ldquoproofrdquo of harm materializes slowly Since ldquoproofrdquo of harm materializes slowly generations are at risk and may be harmed generations are at risk and may be harmed before adequate regulatory response occursbefore adequate regulatory response occurs

Kaiser amp HCWHh2eKaiser amp HCWHh2e

Clean Diesel Hospital Zones ProjectClean Diesel Hospital Zones Project Healthy Food in Healthcare InitiativeHealthy Food in Healthcare Initiative Green Building PVC and DEHP free Green Building PVC and DEHP free

NICU NICU Environmentally preferable purchasing Environmentally preferable purchasing

policypolicy Making Medicine Mercury Free Award Making Medicine Mercury Free Award h2e Environmental Leadership Award h2e Environmental Leadership Award

20022002

What Can You DoWhat Can You Do

Be aware of environmental toxins amp Be aware of environmental toxins amp their possible links to chronic diseasestheir possible links to chronic diseases

Provide advice amp education on Provide advice amp education on prevention andor minimizing prevention andor minimizing exposures or refer appropriately exposures or refer appropriately

Incorporate environmental questions Incorporate environmental questions into clinical historyinto clinical history

Advocate Advocate wwwenvirohealthactionorgwwwenvirohealthactionorg

Local AdvocacyLocal Advocacy Oregon Environmental CouncilOregon Environmental Council wwwoeconlineorgwwwoeconlineorg Oregon Collaborative on Health amp Oregon Collaborative on Health amp

EnvironmentEnvironment Healthy Environment ForumsHealthy Environment Forums Oregon Center for Environmental HealthOregon Center for Environmental Health wwworegon-healthorgwwworegon-healthorg Healthcare without HarmHealthcare without Harm Hospitals for Healthy Environment (h2e)Hospitals for Healthy Environment (h2e) Oregon PSROregon PSR wwworegonpsrorgwwworegonpsrorg Environmental Health-In Harmrsquos Way Environmental Health-In Harmrsquos Way

Sources of PesticidesSources of Pesticides

Household uses lawn amp garden Household uses lawn amp garden sprays exterminators flea collarssprays exterminators flea collars

Household dust (tracking in on shoes)Household dust (tracking in on shoes)

Public schools hospitals parks Public schools hospitals parks childcare facilitieschildcare facilities

Agricultural uses amp workersrsquo clothesAgricultural uses amp workersrsquo clothes

Non-organic foodsNon-organic foods

Breast milkBreast milk

Strategies to Reduces Strategies to Reduces Exposure to Home amp Garden Exposure to Home amp Garden

Pesticides in OregonPesticides in OregonPolicy SolutionsPolicy Solutions OR pesticide use reporting system OR pesticide use reporting system

(1999) finally funded 2005(1999) finally funded 2005 Educate homeowners re nontoxic Educate homeowners re nontoxic

options options Enc pet owners to use flea combs and Enc pet owners to use flea combs and

vacuuming to control fleasvacuuming to control fleas Enc public places to use Integrated Enc public places to use Integrated

Pest Management (IPM) ie Pesticide Pest Management (IPM) ie Pesticide Free ParksFree Parks

What YOU Can Do about What YOU Can Do about PesticidesPesticides

Advise PatientsAdvise Patients Regularly dustRegularly dust Use Integrated Pest Management Use Integrated Pest Management Cleanremove shoes outsideCleanremove shoes outside Keep contaminated clothes separateKeep contaminated clothes separate Buy sustainably grown foodBuy sustainably grown food Store food in secure nontoxic Store food in secure nontoxic

containerscontainers

Mercury amp Women of Mercury amp Women of Childbearing AgeChildbearing Age

A 32 yo G0P0 woman of A 32 yo G0P0 woman of childbearing age (WCBA) childbearing age (WCBA) presents for annual PE presents for annual PE

PMH negativePMH negative

Social hx husband is Social hx husband is recreational fisherman recreational fisherman

Contemplating pregnancy Contemplating pregnancy

Should she avoid fish Should she avoid fish because of mercury risks because of mercury risks to the fetusto the fetus

Mercury amp WCBAMercury amp WCBA

gt10gt10 of WCBA exceed safe limit of of WCBA exceed safe limit of 1ugkgday1ugkgday

5050 of women of women who eat fishwho eat fish exceed exceed limitlimit

5757 of WCBA have Hg levels of WCBA have Hg levels concerning for adverse effects concerning for adverse effects (CDC (CDC Natrsquol Report 0705Natrsquol Report 0705))

Higher risk Higher risk 300 000 childrenyear 300 000 childrenyear subsistence fishers immigrants subsistence fishers immigrants Native AmericansNative Americans

Mercury amp WCBAMercury amp WCBA

Hg enters tissues variable excretionHg enters tissues variable excretion Breast Milk PCBs DDT amp other Breast Milk PCBs DDT amp other

pesticides dioxins dibenzofurans pesticides dioxins dibenzofurans toxic flame retardants amp heavy toxic flame retardants amp heavy metals (Pb amp Hg) metals (Pb amp Hg)

No bio-accumulation in milk but No bio-accumulation in milk but levels in fish-eaters may exceed levels in fish-eaters may exceed unexposed women by 100x unexposed women by 100x

Scientific evidence indicates Scientific evidence indicates advantages of breast-feeding advantages of breast-feeding outweigh riskshellipoutweigh riskshellip

Neuro Effects of MercuryNeuro Effects of Mercury

Cerebral palsyCerebral palsy MRDDMRDD disequilibrium ataxiadisequilibrium ataxia hearing lossdeafnesshearing lossdeafness visual visual

impairmentblindnessimpairmentblindness peripheral neuropathyperipheral neuropathy parasthesiasparasthesias tremors seizures tremors seizures abnl reflexes amp muscle toneabnl reflexes amp muscle tone Psychiatric disturbances Psychiatric disturbances

Mercury a Persistent Mercury a Persistent ProblemProblem

PoisoningsPoisonings Minamata 1950s amp Iraq Minamata 1950s amp Iraq 19711971

Nationally ~Nationally ~160 tons of Hg annually160 tons of Hg annually In OregonIn Oregon ~ ~4500 lbs annually4500 lbs annually Lack of regulationLack of regulation In OR 10 facilities In OR 10 facilities

report Hg release-none has a permit or is report Hg release-none has a permit or is required to monitor emissions by staterequired to monitor emissions by state

Fish AdvisoriesFish Advisories in 2004 45 states had in 2004 45 states had gt2000 warnings Oregon lists advisories gt2000 warnings Oregon lists advisories for 12 water bodies inc Willamette for 12 water bodies inc Willamette

Atmospheric HgAtmospheric Hg

The Mercury CycleThe Mercury Cycle

MercuryMercuryDeclining Threshold of Declining Threshold of

HarmHarm

2000199019801970001

01

1

10

100

YEAR

Level associated with harmful effectRegulatory standard (maximum safe exposure or high end exposure from allowed fish contamination)

FDA WHO

EPA

ATSDR

DA

ILY

IN

TA

KE

(mic

rogr

ams

kg

day

Hg)

Sources of MercurySources of MercuryIndustrial emissions Industrial emissions

coal fired plantscoal fired plantsMunicipal amp medical Municipal amp medical

waste incineratorswaste incineratorsAbandoned Hg amp gold Abandoned Hg amp gold

minesminesNatural off-gassing Natural off-gassing Dental amalgamsDental amalgamsBioaccumulation in Bioaccumulation in

foods esp fishfoods esp fishOld thermometers BP Old thermometers BP

cuffs amp auto cuffs amp auto switchesswitches

Strategies to Reduce Strategies to Reduce Mercury Pollution in Mercury Pollution in

OregonOregonPolicy SolutionsPolicy Solutions Mercury Solutions Act of 2001Mercury Solutions Act of 2001 Ensure safe collection amp recyclingEnsure safe collection amp recycling Clean up abandoned mines and Clean up abandoned mines and

SuperfundsSuperfunds Reduce Hg emissions from health Reduce Hg emissions from health

care facilitiescare facilities Inc Hg in applicable DEQ air amp Inc Hg in applicable DEQ air amp

water permitswater permits Coal burning power plant Boardman Coal burning power plant Boardman

OR OR Implement OR Executive OrderImplement OR Executive Order

What YOU Can Do about What YOU Can Do about MercuryMercury

Advise PatientsAdvise Patients Provide Provide An Expectant Motherrsquos Guide to An Expectant Motherrsquos Guide to

Eating Fish in Oregon (DHS) Eating Fish in Oregon (DHS) in waiting in waiting roomsrooms

Rec WCBA and children avoid fish wHgRec WCBA and children avoid fish wHg Enc WCBA to consume low-fat dietEnc WCBA to consume low-fat diet Recycle old Hg thermometers Recycle old Hg thermometers

thermostats amp fluorescent light tubesthermostats amp fluorescent light tubes Have car checked for Hg switches at Have car checked for Hg switches at

participating auto shop (free participating auto shop (free replacement)replacement)

Use digital thermometers amp thermostatsUse digital thermometers amp thermostats

SummarySummary Chronic Diseases are prevalent Toxic Chronic Diseases are prevalent Toxic

exposures are possible exposures are possible preventablepreventable contributorscontributors

Pesticides amp risk of Parkinsonrsquos and Mercury Pesticides amp risk of Parkinsonrsquos and Mercury risks to WCBA are more understood than most risks to WCBA are more understood than most toxins and other chronic diseasestoxins and other chronic diseases

Apparent toxicity at high doses should be a Apparent toxicity at high doses should be a red flag for possible harm from low dose red flag for possible harm from low dose chronic exposureschronic exposures

Since ldquoproofrdquo of harm materializes slowly Since ldquoproofrdquo of harm materializes slowly generations are at risk and may be harmed generations are at risk and may be harmed before adequate regulatory response occursbefore adequate regulatory response occurs

Kaiser amp HCWHh2eKaiser amp HCWHh2e

Clean Diesel Hospital Zones ProjectClean Diesel Hospital Zones Project Healthy Food in Healthcare InitiativeHealthy Food in Healthcare Initiative Green Building PVC and DEHP free Green Building PVC and DEHP free

NICU NICU Environmentally preferable purchasing Environmentally preferable purchasing

policypolicy Making Medicine Mercury Free Award Making Medicine Mercury Free Award h2e Environmental Leadership Award h2e Environmental Leadership Award

20022002

What Can You DoWhat Can You Do

Be aware of environmental toxins amp Be aware of environmental toxins amp their possible links to chronic diseasestheir possible links to chronic diseases

Provide advice amp education on Provide advice amp education on prevention andor minimizing prevention andor minimizing exposures or refer appropriately exposures or refer appropriately

Incorporate environmental questions Incorporate environmental questions into clinical historyinto clinical history

Advocate Advocate wwwenvirohealthactionorgwwwenvirohealthactionorg

Local AdvocacyLocal Advocacy Oregon Environmental CouncilOregon Environmental Council wwwoeconlineorgwwwoeconlineorg Oregon Collaborative on Health amp Oregon Collaborative on Health amp

EnvironmentEnvironment Healthy Environment ForumsHealthy Environment Forums Oregon Center for Environmental HealthOregon Center for Environmental Health wwworegon-healthorgwwworegon-healthorg Healthcare without HarmHealthcare without Harm Hospitals for Healthy Environment (h2e)Hospitals for Healthy Environment (h2e) Oregon PSROregon PSR wwworegonpsrorgwwworegonpsrorg Environmental Health-In Harmrsquos Way Environmental Health-In Harmrsquos Way

Strategies to Reduces Strategies to Reduces Exposure to Home amp Garden Exposure to Home amp Garden

Pesticides in OregonPesticides in OregonPolicy SolutionsPolicy Solutions OR pesticide use reporting system OR pesticide use reporting system

(1999) finally funded 2005(1999) finally funded 2005 Educate homeowners re nontoxic Educate homeowners re nontoxic

options options Enc pet owners to use flea combs and Enc pet owners to use flea combs and

vacuuming to control fleasvacuuming to control fleas Enc public places to use Integrated Enc public places to use Integrated

Pest Management (IPM) ie Pesticide Pest Management (IPM) ie Pesticide Free ParksFree Parks

What YOU Can Do about What YOU Can Do about PesticidesPesticides

Advise PatientsAdvise Patients Regularly dustRegularly dust Use Integrated Pest Management Use Integrated Pest Management Cleanremove shoes outsideCleanremove shoes outside Keep contaminated clothes separateKeep contaminated clothes separate Buy sustainably grown foodBuy sustainably grown food Store food in secure nontoxic Store food in secure nontoxic

containerscontainers

Mercury amp Women of Mercury amp Women of Childbearing AgeChildbearing Age

A 32 yo G0P0 woman of A 32 yo G0P0 woman of childbearing age (WCBA) childbearing age (WCBA) presents for annual PE presents for annual PE

PMH negativePMH negative

Social hx husband is Social hx husband is recreational fisherman recreational fisherman

Contemplating pregnancy Contemplating pregnancy

Should she avoid fish Should she avoid fish because of mercury risks because of mercury risks to the fetusto the fetus

Mercury amp WCBAMercury amp WCBA

gt10gt10 of WCBA exceed safe limit of of WCBA exceed safe limit of 1ugkgday1ugkgday

5050 of women of women who eat fishwho eat fish exceed exceed limitlimit

5757 of WCBA have Hg levels of WCBA have Hg levels concerning for adverse effects concerning for adverse effects (CDC (CDC Natrsquol Report 0705Natrsquol Report 0705))

Higher risk Higher risk 300 000 childrenyear 300 000 childrenyear subsistence fishers immigrants subsistence fishers immigrants Native AmericansNative Americans

Mercury amp WCBAMercury amp WCBA

Hg enters tissues variable excretionHg enters tissues variable excretion Breast Milk PCBs DDT amp other Breast Milk PCBs DDT amp other

pesticides dioxins dibenzofurans pesticides dioxins dibenzofurans toxic flame retardants amp heavy toxic flame retardants amp heavy metals (Pb amp Hg) metals (Pb amp Hg)

No bio-accumulation in milk but No bio-accumulation in milk but levels in fish-eaters may exceed levels in fish-eaters may exceed unexposed women by 100x unexposed women by 100x

Scientific evidence indicates Scientific evidence indicates advantages of breast-feeding advantages of breast-feeding outweigh riskshellipoutweigh riskshellip

Neuro Effects of MercuryNeuro Effects of Mercury

Cerebral palsyCerebral palsy MRDDMRDD disequilibrium ataxiadisequilibrium ataxia hearing lossdeafnesshearing lossdeafness visual visual

impairmentblindnessimpairmentblindness peripheral neuropathyperipheral neuropathy parasthesiasparasthesias tremors seizures tremors seizures abnl reflexes amp muscle toneabnl reflexes amp muscle tone Psychiatric disturbances Psychiatric disturbances

Mercury a Persistent Mercury a Persistent ProblemProblem

PoisoningsPoisonings Minamata 1950s amp Iraq Minamata 1950s amp Iraq 19711971

Nationally ~Nationally ~160 tons of Hg annually160 tons of Hg annually In OregonIn Oregon ~ ~4500 lbs annually4500 lbs annually Lack of regulationLack of regulation In OR 10 facilities In OR 10 facilities

report Hg release-none has a permit or is report Hg release-none has a permit or is required to monitor emissions by staterequired to monitor emissions by state

Fish AdvisoriesFish Advisories in 2004 45 states had in 2004 45 states had gt2000 warnings Oregon lists advisories gt2000 warnings Oregon lists advisories for 12 water bodies inc Willamette for 12 water bodies inc Willamette

Atmospheric HgAtmospheric Hg

The Mercury CycleThe Mercury Cycle

MercuryMercuryDeclining Threshold of Declining Threshold of

HarmHarm

2000199019801970001

01

1

10

100

YEAR

Level associated with harmful effectRegulatory standard (maximum safe exposure or high end exposure from allowed fish contamination)

FDA WHO

EPA

ATSDR

DA

ILY

IN

TA

KE

(mic

rogr

ams

kg

day

Hg)

Sources of MercurySources of MercuryIndustrial emissions Industrial emissions

coal fired plantscoal fired plantsMunicipal amp medical Municipal amp medical

waste incineratorswaste incineratorsAbandoned Hg amp gold Abandoned Hg amp gold

minesminesNatural off-gassing Natural off-gassing Dental amalgamsDental amalgamsBioaccumulation in Bioaccumulation in

foods esp fishfoods esp fishOld thermometers BP Old thermometers BP

cuffs amp auto cuffs amp auto switchesswitches

Strategies to Reduce Strategies to Reduce Mercury Pollution in Mercury Pollution in

OregonOregonPolicy SolutionsPolicy Solutions Mercury Solutions Act of 2001Mercury Solutions Act of 2001 Ensure safe collection amp recyclingEnsure safe collection amp recycling Clean up abandoned mines and Clean up abandoned mines and

SuperfundsSuperfunds Reduce Hg emissions from health Reduce Hg emissions from health

care facilitiescare facilities Inc Hg in applicable DEQ air amp Inc Hg in applicable DEQ air amp

water permitswater permits Coal burning power plant Boardman Coal burning power plant Boardman

OR OR Implement OR Executive OrderImplement OR Executive Order

What YOU Can Do about What YOU Can Do about MercuryMercury

Advise PatientsAdvise Patients Provide Provide An Expectant Motherrsquos Guide to An Expectant Motherrsquos Guide to

Eating Fish in Oregon (DHS) Eating Fish in Oregon (DHS) in waiting in waiting roomsrooms

Rec WCBA and children avoid fish wHgRec WCBA and children avoid fish wHg Enc WCBA to consume low-fat dietEnc WCBA to consume low-fat diet Recycle old Hg thermometers Recycle old Hg thermometers

thermostats amp fluorescent light tubesthermostats amp fluorescent light tubes Have car checked for Hg switches at Have car checked for Hg switches at

participating auto shop (free participating auto shop (free replacement)replacement)

Use digital thermometers amp thermostatsUse digital thermometers amp thermostats

SummarySummary Chronic Diseases are prevalent Toxic Chronic Diseases are prevalent Toxic

exposures are possible exposures are possible preventablepreventable contributorscontributors

Pesticides amp risk of Parkinsonrsquos and Mercury Pesticides amp risk of Parkinsonrsquos and Mercury risks to WCBA are more understood than most risks to WCBA are more understood than most toxins and other chronic diseasestoxins and other chronic diseases

Apparent toxicity at high doses should be a Apparent toxicity at high doses should be a red flag for possible harm from low dose red flag for possible harm from low dose chronic exposureschronic exposures

Since ldquoproofrdquo of harm materializes slowly Since ldquoproofrdquo of harm materializes slowly generations are at risk and may be harmed generations are at risk and may be harmed before adequate regulatory response occursbefore adequate regulatory response occurs

Kaiser amp HCWHh2eKaiser amp HCWHh2e

Clean Diesel Hospital Zones ProjectClean Diesel Hospital Zones Project Healthy Food in Healthcare InitiativeHealthy Food in Healthcare Initiative Green Building PVC and DEHP free Green Building PVC and DEHP free

NICU NICU Environmentally preferable purchasing Environmentally preferable purchasing

policypolicy Making Medicine Mercury Free Award Making Medicine Mercury Free Award h2e Environmental Leadership Award h2e Environmental Leadership Award

20022002

What Can You DoWhat Can You Do

Be aware of environmental toxins amp Be aware of environmental toxins amp their possible links to chronic diseasestheir possible links to chronic diseases

Provide advice amp education on Provide advice amp education on prevention andor minimizing prevention andor minimizing exposures or refer appropriately exposures or refer appropriately

Incorporate environmental questions Incorporate environmental questions into clinical historyinto clinical history

Advocate Advocate wwwenvirohealthactionorgwwwenvirohealthactionorg

Local AdvocacyLocal Advocacy Oregon Environmental CouncilOregon Environmental Council wwwoeconlineorgwwwoeconlineorg Oregon Collaborative on Health amp Oregon Collaborative on Health amp

EnvironmentEnvironment Healthy Environment ForumsHealthy Environment Forums Oregon Center for Environmental HealthOregon Center for Environmental Health wwworegon-healthorgwwworegon-healthorg Healthcare without HarmHealthcare without Harm Hospitals for Healthy Environment (h2e)Hospitals for Healthy Environment (h2e) Oregon PSROregon PSR wwworegonpsrorgwwworegonpsrorg Environmental Health-In Harmrsquos Way Environmental Health-In Harmrsquos Way

What YOU Can Do about What YOU Can Do about PesticidesPesticides

Advise PatientsAdvise Patients Regularly dustRegularly dust Use Integrated Pest Management Use Integrated Pest Management Cleanremove shoes outsideCleanremove shoes outside Keep contaminated clothes separateKeep contaminated clothes separate Buy sustainably grown foodBuy sustainably grown food Store food in secure nontoxic Store food in secure nontoxic

containerscontainers

Mercury amp Women of Mercury amp Women of Childbearing AgeChildbearing Age

A 32 yo G0P0 woman of A 32 yo G0P0 woman of childbearing age (WCBA) childbearing age (WCBA) presents for annual PE presents for annual PE

PMH negativePMH negative

Social hx husband is Social hx husband is recreational fisherman recreational fisherman

Contemplating pregnancy Contemplating pregnancy

Should she avoid fish Should she avoid fish because of mercury risks because of mercury risks to the fetusto the fetus

Mercury amp WCBAMercury amp WCBA

gt10gt10 of WCBA exceed safe limit of of WCBA exceed safe limit of 1ugkgday1ugkgday

5050 of women of women who eat fishwho eat fish exceed exceed limitlimit

5757 of WCBA have Hg levels of WCBA have Hg levels concerning for adverse effects concerning for adverse effects (CDC (CDC Natrsquol Report 0705Natrsquol Report 0705))

Higher risk Higher risk 300 000 childrenyear 300 000 childrenyear subsistence fishers immigrants subsistence fishers immigrants Native AmericansNative Americans

Mercury amp WCBAMercury amp WCBA

Hg enters tissues variable excretionHg enters tissues variable excretion Breast Milk PCBs DDT amp other Breast Milk PCBs DDT amp other

pesticides dioxins dibenzofurans pesticides dioxins dibenzofurans toxic flame retardants amp heavy toxic flame retardants amp heavy metals (Pb amp Hg) metals (Pb amp Hg)

No bio-accumulation in milk but No bio-accumulation in milk but levels in fish-eaters may exceed levels in fish-eaters may exceed unexposed women by 100x unexposed women by 100x

Scientific evidence indicates Scientific evidence indicates advantages of breast-feeding advantages of breast-feeding outweigh riskshellipoutweigh riskshellip

Neuro Effects of MercuryNeuro Effects of Mercury

Cerebral palsyCerebral palsy MRDDMRDD disequilibrium ataxiadisequilibrium ataxia hearing lossdeafnesshearing lossdeafness visual visual

impairmentblindnessimpairmentblindness peripheral neuropathyperipheral neuropathy parasthesiasparasthesias tremors seizures tremors seizures abnl reflexes amp muscle toneabnl reflexes amp muscle tone Psychiatric disturbances Psychiatric disturbances

Mercury a Persistent Mercury a Persistent ProblemProblem

PoisoningsPoisonings Minamata 1950s amp Iraq Minamata 1950s amp Iraq 19711971

Nationally ~Nationally ~160 tons of Hg annually160 tons of Hg annually In OregonIn Oregon ~ ~4500 lbs annually4500 lbs annually Lack of regulationLack of regulation In OR 10 facilities In OR 10 facilities

report Hg release-none has a permit or is report Hg release-none has a permit or is required to monitor emissions by staterequired to monitor emissions by state

Fish AdvisoriesFish Advisories in 2004 45 states had in 2004 45 states had gt2000 warnings Oregon lists advisories gt2000 warnings Oregon lists advisories for 12 water bodies inc Willamette for 12 water bodies inc Willamette

Atmospheric HgAtmospheric Hg

The Mercury CycleThe Mercury Cycle

MercuryMercuryDeclining Threshold of Declining Threshold of

HarmHarm

2000199019801970001

01

1

10

100

YEAR

Level associated with harmful effectRegulatory standard (maximum safe exposure or high end exposure from allowed fish contamination)

FDA WHO

EPA

ATSDR

DA

ILY

IN

TA

KE

(mic

rogr

ams

kg

day

Hg)

Sources of MercurySources of MercuryIndustrial emissions Industrial emissions

coal fired plantscoal fired plantsMunicipal amp medical Municipal amp medical

waste incineratorswaste incineratorsAbandoned Hg amp gold Abandoned Hg amp gold

minesminesNatural off-gassing Natural off-gassing Dental amalgamsDental amalgamsBioaccumulation in Bioaccumulation in

foods esp fishfoods esp fishOld thermometers BP Old thermometers BP

cuffs amp auto cuffs amp auto switchesswitches

Strategies to Reduce Strategies to Reduce Mercury Pollution in Mercury Pollution in

OregonOregonPolicy SolutionsPolicy Solutions Mercury Solutions Act of 2001Mercury Solutions Act of 2001 Ensure safe collection amp recyclingEnsure safe collection amp recycling Clean up abandoned mines and Clean up abandoned mines and

SuperfundsSuperfunds Reduce Hg emissions from health Reduce Hg emissions from health

care facilitiescare facilities Inc Hg in applicable DEQ air amp Inc Hg in applicable DEQ air amp

water permitswater permits Coal burning power plant Boardman Coal burning power plant Boardman

OR OR Implement OR Executive OrderImplement OR Executive Order

What YOU Can Do about What YOU Can Do about MercuryMercury

Advise PatientsAdvise Patients Provide Provide An Expectant Motherrsquos Guide to An Expectant Motherrsquos Guide to

Eating Fish in Oregon (DHS) Eating Fish in Oregon (DHS) in waiting in waiting roomsrooms

Rec WCBA and children avoid fish wHgRec WCBA and children avoid fish wHg Enc WCBA to consume low-fat dietEnc WCBA to consume low-fat diet Recycle old Hg thermometers Recycle old Hg thermometers

thermostats amp fluorescent light tubesthermostats amp fluorescent light tubes Have car checked for Hg switches at Have car checked for Hg switches at

participating auto shop (free participating auto shop (free replacement)replacement)

Use digital thermometers amp thermostatsUse digital thermometers amp thermostats

SummarySummary Chronic Diseases are prevalent Toxic Chronic Diseases are prevalent Toxic

exposures are possible exposures are possible preventablepreventable contributorscontributors

Pesticides amp risk of Parkinsonrsquos and Mercury Pesticides amp risk of Parkinsonrsquos and Mercury risks to WCBA are more understood than most risks to WCBA are more understood than most toxins and other chronic diseasestoxins and other chronic diseases

Apparent toxicity at high doses should be a Apparent toxicity at high doses should be a red flag for possible harm from low dose red flag for possible harm from low dose chronic exposureschronic exposures

Since ldquoproofrdquo of harm materializes slowly Since ldquoproofrdquo of harm materializes slowly generations are at risk and may be harmed generations are at risk and may be harmed before adequate regulatory response occursbefore adequate regulatory response occurs

Kaiser amp HCWHh2eKaiser amp HCWHh2e

Clean Diesel Hospital Zones ProjectClean Diesel Hospital Zones Project Healthy Food in Healthcare InitiativeHealthy Food in Healthcare Initiative Green Building PVC and DEHP free Green Building PVC and DEHP free

NICU NICU Environmentally preferable purchasing Environmentally preferable purchasing

policypolicy Making Medicine Mercury Free Award Making Medicine Mercury Free Award h2e Environmental Leadership Award h2e Environmental Leadership Award

20022002

What Can You DoWhat Can You Do

Be aware of environmental toxins amp Be aware of environmental toxins amp their possible links to chronic diseasestheir possible links to chronic diseases

Provide advice amp education on Provide advice amp education on prevention andor minimizing prevention andor minimizing exposures or refer appropriately exposures or refer appropriately

Incorporate environmental questions Incorporate environmental questions into clinical historyinto clinical history

Advocate Advocate wwwenvirohealthactionorgwwwenvirohealthactionorg

Local AdvocacyLocal Advocacy Oregon Environmental CouncilOregon Environmental Council wwwoeconlineorgwwwoeconlineorg Oregon Collaborative on Health amp Oregon Collaborative on Health amp

EnvironmentEnvironment Healthy Environment ForumsHealthy Environment Forums Oregon Center for Environmental HealthOregon Center for Environmental Health wwworegon-healthorgwwworegon-healthorg Healthcare without HarmHealthcare without Harm Hospitals for Healthy Environment (h2e)Hospitals for Healthy Environment (h2e) Oregon PSROregon PSR wwworegonpsrorgwwworegonpsrorg Environmental Health-In Harmrsquos Way Environmental Health-In Harmrsquos Way

Mercury amp Women of Mercury amp Women of Childbearing AgeChildbearing Age

A 32 yo G0P0 woman of A 32 yo G0P0 woman of childbearing age (WCBA) childbearing age (WCBA) presents for annual PE presents for annual PE

PMH negativePMH negative

Social hx husband is Social hx husband is recreational fisherman recreational fisherman

Contemplating pregnancy Contemplating pregnancy

Should she avoid fish Should she avoid fish because of mercury risks because of mercury risks to the fetusto the fetus

Mercury amp WCBAMercury amp WCBA

gt10gt10 of WCBA exceed safe limit of of WCBA exceed safe limit of 1ugkgday1ugkgday

5050 of women of women who eat fishwho eat fish exceed exceed limitlimit

5757 of WCBA have Hg levels of WCBA have Hg levels concerning for adverse effects concerning for adverse effects (CDC (CDC Natrsquol Report 0705Natrsquol Report 0705))

Higher risk Higher risk 300 000 childrenyear 300 000 childrenyear subsistence fishers immigrants subsistence fishers immigrants Native AmericansNative Americans

Mercury amp WCBAMercury amp WCBA

Hg enters tissues variable excretionHg enters tissues variable excretion Breast Milk PCBs DDT amp other Breast Milk PCBs DDT amp other

pesticides dioxins dibenzofurans pesticides dioxins dibenzofurans toxic flame retardants amp heavy toxic flame retardants amp heavy metals (Pb amp Hg) metals (Pb amp Hg)

No bio-accumulation in milk but No bio-accumulation in milk but levels in fish-eaters may exceed levels in fish-eaters may exceed unexposed women by 100x unexposed women by 100x

Scientific evidence indicates Scientific evidence indicates advantages of breast-feeding advantages of breast-feeding outweigh riskshellipoutweigh riskshellip

Neuro Effects of MercuryNeuro Effects of Mercury

Cerebral palsyCerebral palsy MRDDMRDD disequilibrium ataxiadisequilibrium ataxia hearing lossdeafnesshearing lossdeafness visual visual

impairmentblindnessimpairmentblindness peripheral neuropathyperipheral neuropathy parasthesiasparasthesias tremors seizures tremors seizures abnl reflexes amp muscle toneabnl reflexes amp muscle tone Psychiatric disturbances Psychiatric disturbances

Mercury a Persistent Mercury a Persistent ProblemProblem

PoisoningsPoisonings Minamata 1950s amp Iraq Minamata 1950s amp Iraq 19711971

Nationally ~Nationally ~160 tons of Hg annually160 tons of Hg annually In OregonIn Oregon ~ ~4500 lbs annually4500 lbs annually Lack of regulationLack of regulation In OR 10 facilities In OR 10 facilities

report Hg release-none has a permit or is report Hg release-none has a permit or is required to monitor emissions by staterequired to monitor emissions by state

Fish AdvisoriesFish Advisories in 2004 45 states had in 2004 45 states had gt2000 warnings Oregon lists advisories gt2000 warnings Oregon lists advisories for 12 water bodies inc Willamette for 12 water bodies inc Willamette

Atmospheric HgAtmospheric Hg

The Mercury CycleThe Mercury Cycle

MercuryMercuryDeclining Threshold of Declining Threshold of

HarmHarm

2000199019801970001

01

1

10

100

YEAR

Level associated with harmful effectRegulatory standard (maximum safe exposure or high end exposure from allowed fish contamination)

FDA WHO

EPA

ATSDR

DA

ILY

IN

TA

KE

(mic

rogr

ams

kg

day

Hg)

Sources of MercurySources of MercuryIndustrial emissions Industrial emissions

coal fired plantscoal fired plantsMunicipal amp medical Municipal amp medical

waste incineratorswaste incineratorsAbandoned Hg amp gold Abandoned Hg amp gold

minesminesNatural off-gassing Natural off-gassing Dental amalgamsDental amalgamsBioaccumulation in Bioaccumulation in

foods esp fishfoods esp fishOld thermometers BP Old thermometers BP

cuffs amp auto cuffs amp auto switchesswitches

Strategies to Reduce Strategies to Reduce Mercury Pollution in Mercury Pollution in

OregonOregonPolicy SolutionsPolicy Solutions Mercury Solutions Act of 2001Mercury Solutions Act of 2001 Ensure safe collection amp recyclingEnsure safe collection amp recycling Clean up abandoned mines and Clean up abandoned mines and

SuperfundsSuperfunds Reduce Hg emissions from health Reduce Hg emissions from health

care facilitiescare facilities Inc Hg in applicable DEQ air amp Inc Hg in applicable DEQ air amp

water permitswater permits Coal burning power plant Boardman Coal burning power plant Boardman

OR OR Implement OR Executive OrderImplement OR Executive Order

What YOU Can Do about What YOU Can Do about MercuryMercury

Advise PatientsAdvise Patients Provide Provide An Expectant Motherrsquos Guide to An Expectant Motherrsquos Guide to

Eating Fish in Oregon (DHS) Eating Fish in Oregon (DHS) in waiting in waiting roomsrooms

Rec WCBA and children avoid fish wHgRec WCBA and children avoid fish wHg Enc WCBA to consume low-fat dietEnc WCBA to consume low-fat diet Recycle old Hg thermometers Recycle old Hg thermometers

thermostats amp fluorescent light tubesthermostats amp fluorescent light tubes Have car checked for Hg switches at Have car checked for Hg switches at

participating auto shop (free participating auto shop (free replacement)replacement)

Use digital thermometers amp thermostatsUse digital thermometers amp thermostats

SummarySummary Chronic Diseases are prevalent Toxic Chronic Diseases are prevalent Toxic

exposures are possible exposures are possible preventablepreventable contributorscontributors

Pesticides amp risk of Parkinsonrsquos and Mercury Pesticides amp risk of Parkinsonrsquos and Mercury risks to WCBA are more understood than most risks to WCBA are more understood than most toxins and other chronic diseasestoxins and other chronic diseases

Apparent toxicity at high doses should be a Apparent toxicity at high doses should be a red flag for possible harm from low dose red flag for possible harm from low dose chronic exposureschronic exposures

Since ldquoproofrdquo of harm materializes slowly Since ldquoproofrdquo of harm materializes slowly generations are at risk and may be harmed generations are at risk and may be harmed before adequate regulatory response occursbefore adequate regulatory response occurs

Kaiser amp HCWHh2eKaiser amp HCWHh2e

Clean Diesel Hospital Zones ProjectClean Diesel Hospital Zones Project Healthy Food in Healthcare InitiativeHealthy Food in Healthcare Initiative Green Building PVC and DEHP free Green Building PVC and DEHP free

NICU NICU Environmentally preferable purchasing Environmentally preferable purchasing

policypolicy Making Medicine Mercury Free Award Making Medicine Mercury Free Award h2e Environmental Leadership Award h2e Environmental Leadership Award

20022002

What Can You DoWhat Can You Do

Be aware of environmental toxins amp Be aware of environmental toxins amp their possible links to chronic diseasestheir possible links to chronic diseases

Provide advice amp education on Provide advice amp education on prevention andor minimizing prevention andor minimizing exposures or refer appropriately exposures or refer appropriately

Incorporate environmental questions Incorporate environmental questions into clinical historyinto clinical history

Advocate Advocate wwwenvirohealthactionorgwwwenvirohealthactionorg

Local AdvocacyLocal Advocacy Oregon Environmental CouncilOregon Environmental Council wwwoeconlineorgwwwoeconlineorg Oregon Collaborative on Health amp Oregon Collaborative on Health amp

EnvironmentEnvironment Healthy Environment ForumsHealthy Environment Forums Oregon Center for Environmental HealthOregon Center for Environmental Health wwworegon-healthorgwwworegon-healthorg Healthcare without HarmHealthcare without Harm Hospitals for Healthy Environment (h2e)Hospitals for Healthy Environment (h2e) Oregon PSROregon PSR wwworegonpsrorgwwworegonpsrorg Environmental Health-In Harmrsquos Way Environmental Health-In Harmrsquos Way

Mercury amp WCBAMercury amp WCBA

gt10gt10 of WCBA exceed safe limit of of WCBA exceed safe limit of 1ugkgday1ugkgday

5050 of women of women who eat fishwho eat fish exceed exceed limitlimit

5757 of WCBA have Hg levels of WCBA have Hg levels concerning for adverse effects concerning for adverse effects (CDC (CDC Natrsquol Report 0705Natrsquol Report 0705))

Higher risk Higher risk 300 000 childrenyear 300 000 childrenyear subsistence fishers immigrants subsistence fishers immigrants Native AmericansNative Americans

Mercury amp WCBAMercury amp WCBA

Hg enters tissues variable excretionHg enters tissues variable excretion Breast Milk PCBs DDT amp other Breast Milk PCBs DDT amp other

pesticides dioxins dibenzofurans pesticides dioxins dibenzofurans toxic flame retardants amp heavy toxic flame retardants amp heavy metals (Pb amp Hg) metals (Pb amp Hg)

No bio-accumulation in milk but No bio-accumulation in milk but levels in fish-eaters may exceed levels in fish-eaters may exceed unexposed women by 100x unexposed women by 100x

Scientific evidence indicates Scientific evidence indicates advantages of breast-feeding advantages of breast-feeding outweigh riskshellipoutweigh riskshellip

Neuro Effects of MercuryNeuro Effects of Mercury

Cerebral palsyCerebral palsy MRDDMRDD disequilibrium ataxiadisequilibrium ataxia hearing lossdeafnesshearing lossdeafness visual visual

impairmentblindnessimpairmentblindness peripheral neuropathyperipheral neuropathy parasthesiasparasthesias tremors seizures tremors seizures abnl reflexes amp muscle toneabnl reflexes amp muscle tone Psychiatric disturbances Psychiatric disturbances

Mercury a Persistent Mercury a Persistent ProblemProblem

PoisoningsPoisonings Minamata 1950s amp Iraq Minamata 1950s amp Iraq 19711971

Nationally ~Nationally ~160 tons of Hg annually160 tons of Hg annually In OregonIn Oregon ~ ~4500 lbs annually4500 lbs annually Lack of regulationLack of regulation In OR 10 facilities In OR 10 facilities

report Hg release-none has a permit or is report Hg release-none has a permit or is required to monitor emissions by staterequired to monitor emissions by state

Fish AdvisoriesFish Advisories in 2004 45 states had in 2004 45 states had gt2000 warnings Oregon lists advisories gt2000 warnings Oregon lists advisories for 12 water bodies inc Willamette for 12 water bodies inc Willamette

Atmospheric HgAtmospheric Hg

The Mercury CycleThe Mercury Cycle

MercuryMercuryDeclining Threshold of Declining Threshold of

HarmHarm

2000199019801970001

01

1

10

100

YEAR

Level associated with harmful effectRegulatory standard (maximum safe exposure or high end exposure from allowed fish contamination)

FDA WHO

EPA

ATSDR

DA

ILY

IN

TA

KE

(mic

rogr

ams

kg

day

Hg)

Sources of MercurySources of MercuryIndustrial emissions Industrial emissions

coal fired plantscoal fired plantsMunicipal amp medical Municipal amp medical

waste incineratorswaste incineratorsAbandoned Hg amp gold Abandoned Hg amp gold

minesminesNatural off-gassing Natural off-gassing Dental amalgamsDental amalgamsBioaccumulation in Bioaccumulation in

foods esp fishfoods esp fishOld thermometers BP Old thermometers BP

cuffs amp auto cuffs amp auto switchesswitches

Strategies to Reduce Strategies to Reduce Mercury Pollution in Mercury Pollution in

OregonOregonPolicy SolutionsPolicy Solutions Mercury Solutions Act of 2001Mercury Solutions Act of 2001 Ensure safe collection amp recyclingEnsure safe collection amp recycling Clean up abandoned mines and Clean up abandoned mines and

SuperfundsSuperfunds Reduce Hg emissions from health Reduce Hg emissions from health

care facilitiescare facilities Inc Hg in applicable DEQ air amp Inc Hg in applicable DEQ air amp

water permitswater permits Coal burning power plant Boardman Coal burning power plant Boardman

OR OR Implement OR Executive OrderImplement OR Executive Order

What YOU Can Do about What YOU Can Do about MercuryMercury

Advise PatientsAdvise Patients Provide Provide An Expectant Motherrsquos Guide to An Expectant Motherrsquos Guide to

Eating Fish in Oregon (DHS) Eating Fish in Oregon (DHS) in waiting in waiting roomsrooms

Rec WCBA and children avoid fish wHgRec WCBA and children avoid fish wHg Enc WCBA to consume low-fat dietEnc WCBA to consume low-fat diet Recycle old Hg thermometers Recycle old Hg thermometers

thermostats amp fluorescent light tubesthermostats amp fluorescent light tubes Have car checked for Hg switches at Have car checked for Hg switches at

participating auto shop (free participating auto shop (free replacement)replacement)

Use digital thermometers amp thermostatsUse digital thermometers amp thermostats

SummarySummary Chronic Diseases are prevalent Toxic Chronic Diseases are prevalent Toxic

exposures are possible exposures are possible preventablepreventable contributorscontributors

Pesticides amp risk of Parkinsonrsquos and Mercury Pesticides amp risk of Parkinsonrsquos and Mercury risks to WCBA are more understood than most risks to WCBA are more understood than most toxins and other chronic diseasestoxins and other chronic diseases

Apparent toxicity at high doses should be a Apparent toxicity at high doses should be a red flag for possible harm from low dose red flag for possible harm from low dose chronic exposureschronic exposures

Since ldquoproofrdquo of harm materializes slowly Since ldquoproofrdquo of harm materializes slowly generations are at risk and may be harmed generations are at risk and may be harmed before adequate regulatory response occursbefore adequate regulatory response occurs

Kaiser amp HCWHh2eKaiser amp HCWHh2e

Clean Diesel Hospital Zones ProjectClean Diesel Hospital Zones Project Healthy Food in Healthcare InitiativeHealthy Food in Healthcare Initiative Green Building PVC and DEHP free Green Building PVC and DEHP free

NICU NICU Environmentally preferable purchasing Environmentally preferable purchasing

policypolicy Making Medicine Mercury Free Award Making Medicine Mercury Free Award h2e Environmental Leadership Award h2e Environmental Leadership Award

20022002

What Can You DoWhat Can You Do

Be aware of environmental toxins amp Be aware of environmental toxins amp their possible links to chronic diseasestheir possible links to chronic diseases

Provide advice amp education on Provide advice amp education on prevention andor minimizing prevention andor minimizing exposures or refer appropriately exposures or refer appropriately

Incorporate environmental questions Incorporate environmental questions into clinical historyinto clinical history

Advocate Advocate wwwenvirohealthactionorgwwwenvirohealthactionorg

Local AdvocacyLocal Advocacy Oregon Environmental CouncilOregon Environmental Council wwwoeconlineorgwwwoeconlineorg Oregon Collaborative on Health amp Oregon Collaborative on Health amp

EnvironmentEnvironment Healthy Environment ForumsHealthy Environment Forums Oregon Center for Environmental HealthOregon Center for Environmental Health wwworegon-healthorgwwworegon-healthorg Healthcare without HarmHealthcare without Harm Hospitals for Healthy Environment (h2e)Hospitals for Healthy Environment (h2e) Oregon PSROregon PSR wwworegonpsrorgwwworegonpsrorg Environmental Health-In Harmrsquos Way Environmental Health-In Harmrsquos Way

Mercury amp WCBAMercury amp WCBA

Hg enters tissues variable excretionHg enters tissues variable excretion Breast Milk PCBs DDT amp other Breast Milk PCBs DDT amp other

pesticides dioxins dibenzofurans pesticides dioxins dibenzofurans toxic flame retardants amp heavy toxic flame retardants amp heavy metals (Pb amp Hg) metals (Pb amp Hg)

No bio-accumulation in milk but No bio-accumulation in milk but levels in fish-eaters may exceed levels in fish-eaters may exceed unexposed women by 100x unexposed women by 100x

Scientific evidence indicates Scientific evidence indicates advantages of breast-feeding advantages of breast-feeding outweigh riskshellipoutweigh riskshellip

Neuro Effects of MercuryNeuro Effects of Mercury

Cerebral palsyCerebral palsy MRDDMRDD disequilibrium ataxiadisequilibrium ataxia hearing lossdeafnesshearing lossdeafness visual visual

impairmentblindnessimpairmentblindness peripheral neuropathyperipheral neuropathy parasthesiasparasthesias tremors seizures tremors seizures abnl reflexes amp muscle toneabnl reflexes amp muscle tone Psychiatric disturbances Psychiatric disturbances

Mercury a Persistent Mercury a Persistent ProblemProblem

PoisoningsPoisonings Minamata 1950s amp Iraq Minamata 1950s amp Iraq 19711971

Nationally ~Nationally ~160 tons of Hg annually160 tons of Hg annually In OregonIn Oregon ~ ~4500 lbs annually4500 lbs annually Lack of regulationLack of regulation In OR 10 facilities In OR 10 facilities

report Hg release-none has a permit or is report Hg release-none has a permit or is required to monitor emissions by staterequired to monitor emissions by state

Fish AdvisoriesFish Advisories in 2004 45 states had in 2004 45 states had gt2000 warnings Oregon lists advisories gt2000 warnings Oregon lists advisories for 12 water bodies inc Willamette for 12 water bodies inc Willamette

Atmospheric HgAtmospheric Hg

The Mercury CycleThe Mercury Cycle

MercuryMercuryDeclining Threshold of Declining Threshold of

HarmHarm

2000199019801970001

01

1

10

100

YEAR

Level associated with harmful effectRegulatory standard (maximum safe exposure or high end exposure from allowed fish contamination)

FDA WHO

EPA

ATSDR

DA

ILY

IN

TA

KE

(mic

rogr

ams

kg

day

Hg)

Sources of MercurySources of MercuryIndustrial emissions Industrial emissions

coal fired plantscoal fired plantsMunicipal amp medical Municipal amp medical

waste incineratorswaste incineratorsAbandoned Hg amp gold Abandoned Hg amp gold

minesminesNatural off-gassing Natural off-gassing Dental amalgamsDental amalgamsBioaccumulation in Bioaccumulation in

foods esp fishfoods esp fishOld thermometers BP Old thermometers BP

cuffs amp auto cuffs amp auto switchesswitches

Strategies to Reduce Strategies to Reduce Mercury Pollution in Mercury Pollution in

OregonOregonPolicy SolutionsPolicy Solutions Mercury Solutions Act of 2001Mercury Solutions Act of 2001 Ensure safe collection amp recyclingEnsure safe collection amp recycling Clean up abandoned mines and Clean up abandoned mines and

SuperfundsSuperfunds Reduce Hg emissions from health Reduce Hg emissions from health

care facilitiescare facilities Inc Hg in applicable DEQ air amp Inc Hg in applicable DEQ air amp

water permitswater permits Coal burning power plant Boardman Coal burning power plant Boardman

OR OR Implement OR Executive OrderImplement OR Executive Order

What YOU Can Do about What YOU Can Do about MercuryMercury

Advise PatientsAdvise Patients Provide Provide An Expectant Motherrsquos Guide to An Expectant Motherrsquos Guide to

Eating Fish in Oregon (DHS) Eating Fish in Oregon (DHS) in waiting in waiting roomsrooms

Rec WCBA and children avoid fish wHgRec WCBA and children avoid fish wHg Enc WCBA to consume low-fat dietEnc WCBA to consume low-fat diet Recycle old Hg thermometers Recycle old Hg thermometers

thermostats amp fluorescent light tubesthermostats amp fluorescent light tubes Have car checked for Hg switches at Have car checked for Hg switches at

participating auto shop (free participating auto shop (free replacement)replacement)

Use digital thermometers amp thermostatsUse digital thermometers amp thermostats

SummarySummary Chronic Diseases are prevalent Toxic Chronic Diseases are prevalent Toxic

exposures are possible exposures are possible preventablepreventable contributorscontributors

Pesticides amp risk of Parkinsonrsquos and Mercury Pesticides amp risk of Parkinsonrsquos and Mercury risks to WCBA are more understood than most risks to WCBA are more understood than most toxins and other chronic diseasestoxins and other chronic diseases

Apparent toxicity at high doses should be a Apparent toxicity at high doses should be a red flag for possible harm from low dose red flag for possible harm from low dose chronic exposureschronic exposures

Since ldquoproofrdquo of harm materializes slowly Since ldquoproofrdquo of harm materializes slowly generations are at risk and may be harmed generations are at risk and may be harmed before adequate regulatory response occursbefore adequate regulatory response occurs

Kaiser amp HCWHh2eKaiser amp HCWHh2e

Clean Diesel Hospital Zones ProjectClean Diesel Hospital Zones Project Healthy Food in Healthcare InitiativeHealthy Food in Healthcare Initiative Green Building PVC and DEHP free Green Building PVC and DEHP free

NICU NICU Environmentally preferable purchasing Environmentally preferable purchasing

policypolicy Making Medicine Mercury Free Award Making Medicine Mercury Free Award h2e Environmental Leadership Award h2e Environmental Leadership Award

20022002

What Can You DoWhat Can You Do

Be aware of environmental toxins amp Be aware of environmental toxins amp their possible links to chronic diseasestheir possible links to chronic diseases

Provide advice amp education on Provide advice amp education on prevention andor minimizing prevention andor minimizing exposures or refer appropriately exposures or refer appropriately

Incorporate environmental questions Incorporate environmental questions into clinical historyinto clinical history

Advocate Advocate wwwenvirohealthactionorgwwwenvirohealthactionorg

Local AdvocacyLocal Advocacy Oregon Environmental CouncilOregon Environmental Council wwwoeconlineorgwwwoeconlineorg Oregon Collaborative on Health amp Oregon Collaborative on Health amp

EnvironmentEnvironment Healthy Environment ForumsHealthy Environment Forums Oregon Center for Environmental HealthOregon Center for Environmental Health wwworegon-healthorgwwworegon-healthorg Healthcare without HarmHealthcare without Harm Hospitals for Healthy Environment (h2e)Hospitals for Healthy Environment (h2e) Oregon PSROregon PSR wwworegonpsrorgwwworegonpsrorg Environmental Health-In Harmrsquos Way Environmental Health-In Harmrsquos Way

Neuro Effects of MercuryNeuro Effects of Mercury

Cerebral palsyCerebral palsy MRDDMRDD disequilibrium ataxiadisequilibrium ataxia hearing lossdeafnesshearing lossdeafness visual visual

impairmentblindnessimpairmentblindness peripheral neuropathyperipheral neuropathy parasthesiasparasthesias tremors seizures tremors seizures abnl reflexes amp muscle toneabnl reflexes amp muscle tone Psychiatric disturbances Psychiatric disturbances

Mercury a Persistent Mercury a Persistent ProblemProblem

PoisoningsPoisonings Minamata 1950s amp Iraq Minamata 1950s amp Iraq 19711971

Nationally ~Nationally ~160 tons of Hg annually160 tons of Hg annually In OregonIn Oregon ~ ~4500 lbs annually4500 lbs annually Lack of regulationLack of regulation In OR 10 facilities In OR 10 facilities

report Hg release-none has a permit or is report Hg release-none has a permit or is required to monitor emissions by staterequired to monitor emissions by state

Fish AdvisoriesFish Advisories in 2004 45 states had in 2004 45 states had gt2000 warnings Oregon lists advisories gt2000 warnings Oregon lists advisories for 12 water bodies inc Willamette for 12 water bodies inc Willamette

Atmospheric HgAtmospheric Hg

The Mercury CycleThe Mercury Cycle

MercuryMercuryDeclining Threshold of Declining Threshold of

HarmHarm

2000199019801970001

01

1

10

100

YEAR

Level associated with harmful effectRegulatory standard (maximum safe exposure or high end exposure from allowed fish contamination)

FDA WHO

EPA

ATSDR

DA

ILY

IN

TA

KE

(mic

rogr

ams

kg

day

Hg)

Sources of MercurySources of MercuryIndustrial emissions Industrial emissions

coal fired plantscoal fired plantsMunicipal amp medical Municipal amp medical

waste incineratorswaste incineratorsAbandoned Hg amp gold Abandoned Hg amp gold

minesminesNatural off-gassing Natural off-gassing Dental amalgamsDental amalgamsBioaccumulation in Bioaccumulation in

foods esp fishfoods esp fishOld thermometers BP Old thermometers BP

cuffs amp auto cuffs amp auto switchesswitches

Strategies to Reduce Strategies to Reduce Mercury Pollution in Mercury Pollution in

OregonOregonPolicy SolutionsPolicy Solutions Mercury Solutions Act of 2001Mercury Solutions Act of 2001 Ensure safe collection amp recyclingEnsure safe collection amp recycling Clean up abandoned mines and Clean up abandoned mines and

SuperfundsSuperfunds Reduce Hg emissions from health Reduce Hg emissions from health

care facilitiescare facilities Inc Hg in applicable DEQ air amp Inc Hg in applicable DEQ air amp

water permitswater permits Coal burning power plant Boardman Coal burning power plant Boardman

OR OR Implement OR Executive OrderImplement OR Executive Order

What YOU Can Do about What YOU Can Do about MercuryMercury

Advise PatientsAdvise Patients Provide Provide An Expectant Motherrsquos Guide to An Expectant Motherrsquos Guide to

Eating Fish in Oregon (DHS) Eating Fish in Oregon (DHS) in waiting in waiting roomsrooms

Rec WCBA and children avoid fish wHgRec WCBA and children avoid fish wHg Enc WCBA to consume low-fat dietEnc WCBA to consume low-fat diet Recycle old Hg thermometers Recycle old Hg thermometers

thermostats amp fluorescent light tubesthermostats amp fluorescent light tubes Have car checked for Hg switches at Have car checked for Hg switches at

participating auto shop (free participating auto shop (free replacement)replacement)

Use digital thermometers amp thermostatsUse digital thermometers amp thermostats

SummarySummary Chronic Diseases are prevalent Toxic Chronic Diseases are prevalent Toxic

exposures are possible exposures are possible preventablepreventable contributorscontributors

Pesticides amp risk of Parkinsonrsquos and Mercury Pesticides amp risk of Parkinsonrsquos and Mercury risks to WCBA are more understood than most risks to WCBA are more understood than most toxins and other chronic diseasestoxins and other chronic diseases

Apparent toxicity at high doses should be a Apparent toxicity at high doses should be a red flag for possible harm from low dose red flag for possible harm from low dose chronic exposureschronic exposures

Since ldquoproofrdquo of harm materializes slowly Since ldquoproofrdquo of harm materializes slowly generations are at risk and may be harmed generations are at risk and may be harmed before adequate regulatory response occursbefore adequate regulatory response occurs

Kaiser amp HCWHh2eKaiser amp HCWHh2e

Clean Diesel Hospital Zones ProjectClean Diesel Hospital Zones Project Healthy Food in Healthcare InitiativeHealthy Food in Healthcare Initiative Green Building PVC and DEHP free Green Building PVC and DEHP free

NICU NICU Environmentally preferable purchasing Environmentally preferable purchasing

policypolicy Making Medicine Mercury Free Award Making Medicine Mercury Free Award h2e Environmental Leadership Award h2e Environmental Leadership Award

20022002

What Can You DoWhat Can You Do

Be aware of environmental toxins amp Be aware of environmental toxins amp their possible links to chronic diseasestheir possible links to chronic diseases

Provide advice amp education on Provide advice amp education on prevention andor minimizing prevention andor minimizing exposures or refer appropriately exposures or refer appropriately

Incorporate environmental questions Incorporate environmental questions into clinical historyinto clinical history

Advocate Advocate wwwenvirohealthactionorgwwwenvirohealthactionorg

Local AdvocacyLocal Advocacy Oregon Environmental CouncilOregon Environmental Council wwwoeconlineorgwwwoeconlineorg Oregon Collaborative on Health amp Oregon Collaborative on Health amp

EnvironmentEnvironment Healthy Environment ForumsHealthy Environment Forums Oregon Center for Environmental HealthOregon Center for Environmental Health wwworegon-healthorgwwworegon-healthorg Healthcare without HarmHealthcare without Harm Hospitals for Healthy Environment (h2e)Hospitals for Healthy Environment (h2e) Oregon PSROregon PSR wwworegonpsrorgwwworegonpsrorg Environmental Health-In Harmrsquos Way Environmental Health-In Harmrsquos Way

Mercury a Persistent Mercury a Persistent ProblemProblem

PoisoningsPoisonings Minamata 1950s amp Iraq Minamata 1950s amp Iraq 19711971

Nationally ~Nationally ~160 tons of Hg annually160 tons of Hg annually In OregonIn Oregon ~ ~4500 lbs annually4500 lbs annually Lack of regulationLack of regulation In OR 10 facilities In OR 10 facilities

report Hg release-none has a permit or is report Hg release-none has a permit or is required to monitor emissions by staterequired to monitor emissions by state

Fish AdvisoriesFish Advisories in 2004 45 states had in 2004 45 states had gt2000 warnings Oregon lists advisories gt2000 warnings Oregon lists advisories for 12 water bodies inc Willamette for 12 water bodies inc Willamette

Atmospheric HgAtmospheric Hg

The Mercury CycleThe Mercury Cycle

MercuryMercuryDeclining Threshold of Declining Threshold of

HarmHarm

2000199019801970001

01

1

10

100

YEAR

Level associated with harmful effectRegulatory standard (maximum safe exposure or high end exposure from allowed fish contamination)

FDA WHO

EPA

ATSDR

DA

ILY

IN

TA

KE

(mic

rogr

ams

kg

day

Hg)

Sources of MercurySources of MercuryIndustrial emissions Industrial emissions

coal fired plantscoal fired plantsMunicipal amp medical Municipal amp medical

waste incineratorswaste incineratorsAbandoned Hg amp gold Abandoned Hg amp gold

minesminesNatural off-gassing Natural off-gassing Dental amalgamsDental amalgamsBioaccumulation in Bioaccumulation in

foods esp fishfoods esp fishOld thermometers BP Old thermometers BP

cuffs amp auto cuffs amp auto switchesswitches

Strategies to Reduce Strategies to Reduce Mercury Pollution in Mercury Pollution in

OregonOregonPolicy SolutionsPolicy Solutions Mercury Solutions Act of 2001Mercury Solutions Act of 2001 Ensure safe collection amp recyclingEnsure safe collection amp recycling Clean up abandoned mines and Clean up abandoned mines and

SuperfundsSuperfunds Reduce Hg emissions from health Reduce Hg emissions from health

care facilitiescare facilities Inc Hg in applicable DEQ air amp Inc Hg in applicable DEQ air amp

water permitswater permits Coal burning power plant Boardman Coal burning power plant Boardman

OR OR Implement OR Executive OrderImplement OR Executive Order

What YOU Can Do about What YOU Can Do about MercuryMercury

Advise PatientsAdvise Patients Provide Provide An Expectant Motherrsquos Guide to An Expectant Motherrsquos Guide to

Eating Fish in Oregon (DHS) Eating Fish in Oregon (DHS) in waiting in waiting roomsrooms

Rec WCBA and children avoid fish wHgRec WCBA and children avoid fish wHg Enc WCBA to consume low-fat dietEnc WCBA to consume low-fat diet Recycle old Hg thermometers Recycle old Hg thermometers

thermostats amp fluorescent light tubesthermostats amp fluorescent light tubes Have car checked for Hg switches at Have car checked for Hg switches at

participating auto shop (free participating auto shop (free replacement)replacement)

Use digital thermometers amp thermostatsUse digital thermometers amp thermostats

SummarySummary Chronic Diseases are prevalent Toxic Chronic Diseases are prevalent Toxic

exposures are possible exposures are possible preventablepreventable contributorscontributors

Pesticides amp risk of Parkinsonrsquos and Mercury Pesticides amp risk of Parkinsonrsquos and Mercury risks to WCBA are more understood than most risks to WCBA are more understood than most toxins and other chronic diseasestoxins and other chronic diseases

Apparent toxicity at high doses should be a Apparent toxicity at high doses should be a red flag for possible harm from low dose red flag for possible harm from low dose chronic exposureschronic exposures

Since ldquoproofrdquo of harm materializes slowly Since ldquoproofrdquo of harm materializes slowly generations are at risk and may be harmed generations are at risk and may be harmed before adequate regulatory response occursbefore adequate regulatory response occurs

Kaiser amp HCWHh2eKaiser amp HCWHh2e

Clean Diesel Hospital Zones ProjectClean Diesel Hospital Zones Project Healthy Food in Healthcare InitiativeHealthy Food in Healthcare Initiative Green Building PVC and DEHP free Green Building PVC and DEHP free

NICU NICU Environmentally preferable purchasing Environmentally preferable purchasing

policypolicy Making Medicine Mercury Free Award Making Medicine Mercury Free Award h2e Environmental Leadership Award h2e Environmental Leadership Award

20022002

What Can You DoWhat Can You Do

Be aware of environmental toxins amp Be aware of environmental toxins amp their possible links to chronic diseasestheir possible links to chronic diseases

Provide advice amp education on Provide advice amp education on prevention andor minimizing prevention andor minimizing exposures or refer appropriately exposures or refer appropriately

Incorporate environmental questions Incorporate environmental questions into clinical historyinto clinical history

Advocate Advocate wwwenvirohealthactionorgwwwenvirohealthactionorg

Local AdvocacyLocal Advocacy Oregon Environmental CouncilOregon Environmental Council wwwoeconlineorgwwwoeconlineorg Oregon Collaborative on Health amp Oregon Collaborative on Health amp

EnvironmentEnvironment Healthy Environment ForumsHealthy Environment Forums Oregon Center for Environmental HealthOregon Center for Environmental Health wwworegon-healthorgwwworegon-healthorg Healthcare without HarmHealthcare without Harm Hospitals for Healthy Environment (h2e)Hospitals for Healthy Environment (h2e) Oregon PSROregon PSR wwworegonpsrorgwwworegonpsrorg Environmental Health-In Harmrsquos Way Environmental Health-In Harmrsquos Way

Atmospheric HgAtmospheric Hg

The Mercury CycleThe Mercury Cycle

MercuryMercuryDeclining Threshold of Declining Threshold of

HarmHarm

2000199019801970001

01

1

10

100

YEAR

Level associated with harmful effectRegulatory standard (maximum safe exposure or high end exposure from allowed fish contamination)

FDA WHO

EPA

ATSDR

DA

ILY

IN

TA

KE

(mic

rogr

ams

kg

day

Hg)

Sources of MercurySources of MercuryIndustrial emissions Industrial emissions

coal fired plantscoal fired plantsMunicipal amp medical Municipal amp medical

waste incineratorswaste incineratorsAbandoned Hg amp gold Abandoned Hg amp gold

minesminesNatural off-gassing Natural off-gassing Dental amalgamsDental amalgamsBioaccumulation in Bioaccumulation in

foods esp fishfoods esp fishOld thermometers BP Old thermometers BP

cuffs amp auto cuffs amp auto switchesswitches

Strategies to Reduce Strategies to Reduce Mercury Pollution in Mercury Pollution in

OregonOregonPolicy SolutionsPolicy Solutions Mercury Solutions Act of 2001Mercury Solutions Act of 2001 Ensure safe collection amp recyclingEnsure safe collection amp recycling Clean up abandoned mines and Clean up abandoned mines and

SuperfundsSuperfunds Reduce Hg emissions from health Reduce Hg emissions from health

care facilitiescare facilities Inc Hg in applicable DEQ air amp Inc Hg in applicable DEQ air amp

water permitswater permits Coal burning power plant Boardman Coal burning power plant Boardman

OR OR Implement OR Executive OrderImplement OR Executive Order

What YOU Can Do about What YOU Can Do about MercuryMercury

Advise PatientsAdvise Patients Provide Provide An Expectant Motherrsquos Guide to An Expectant Motherrsquos Guide to

Eating Fish in Oregon (DHS) Eating Fish in Oregon (DHS) in waiting in waiting roomsrooms

Rec WCBA and children avoid fish wHgRec WCBA and children avoid fish wHg Enc WCBA to consume low-fat dietEnc WCBA to consume low-fat diet Recycle old Hg thermometers Recycle old Hg thermometers

thermostats amp fluorescent light tubesthermostats amp fluorescent light tubes Have car checked for Hg switches at Have car checked for Hg switches at

participating auto shop (free participating auto shop (free replacement)replacement)

Use digital thermometers amp thermostatsUse digital thermometers amp thermostats

SummarySummary Chronic Diseases are prevalent Toxic Chronic Diseases are prevalent Toxic

exposures are possible exposures are possible preventablepreventable contributorscontributors

Pesticides amp risk of Parkinsonrsquos and Mercury Pesticides amp risk of Parkinsonrsquos and Mercury risks to WCBA are more understood than most risks to WCBA are more understood than most toxins and other chronic diseasestoxins and other chronic diseases

Apparent toxicity at high doses should be a Apparent toxicity at high doses should be a red flag for possible harm from low dose red flag for possible harm from low dose chronic exposureschronic exposures

Since ldquoproofrdquo of harm materializes slowly Since ldquoproofrdquo of harm materializes slowly generations are at risk and may be harmed generations are at risk and may be harmed before adequate regulatory response occursbefore adequate regulatory response occurs

Kaiser amp HCWHh2eKaiser amp HCWHh2e

Clean Diesel Hospital Zones ProjectClean Diesel Hospital Zones Project Healthy Food in Healthcare InitiativeHealthy Food in Healthcare Initiative Green Building PVC and DEHP free Green Building PVC and DEHP free

NICU NICU Environmentally preferable purchasing Environmentally preferable purchasing

policypolicy Making Medicine Mercury Free Award Making Medicine Mercury Free Award h2e Environmental Leadership Award h2e Environmental Leadership Award

20022002

What Can You DoWhat Can You Do

Be aware of environmental toxins amp Be aware of environmental toxins amp their possible links to chronic diseasestheir possible links to chronic diseases

Provide advice amp education on Provide advice amp education on prevention andor minimizing prevention andor minimizing exposures or refer appropriately exposures or refer appropriately

Incorporate environmental questions Incorporate environmental questions into clinical historyinto clinical history

Advocate Advocate wwwenvirohealthactionorgwwwenvirohealthactionorg

Local AdvocacyLocal Advocacy Oregon Environmental CouncilOregon Environmental Council wwwoeconlineorgwwwoeconlineorg Oregon Collaborative on Health amp Oregon Collaborative on Health amp

EnvironmentEnvironment Healthy Environment ForumsHealthy Environment Forums Oregon Center for Environmental HealthOregon Center for Environmental Health wwworegon-healthorgwwworegon-healthorg Healthcare without HarmHealthcare without Harm Hospitals for Healthy Environment (h2e)Hospitals for Healthy Environment (h2e) Oregon PSROregon PSR wwworegonpsrorgwwworegonpsrorg Environmental Health-In Harmrsquos Way Environmental Health-In Harmrsquos Way

The Mercury CycleThe Mercury Cycle

MercuryMercuryDeclining Threshold of Declining Threshold of

HarmHarm

2000199019801970001

01

1

10

100

YEAR

Level associated with harmful effectRegulatory standard (maximum safe exposure or high end exposure from allowed fish contamination)

FDA WHO

EPA

ATSDR

DA

ILY

IN

TA

KE

(mic

rogr

ams

kg

day

Hg)

Sources of MercurySources of MercuryIndustrial emissions Industrial emissions

coal fired plantscoal fired plantsMunicipal amp medical Municipal amp medical

waste incineratorswaste incineratorsAbandoned Hg amp gold Abandoned Hg amp gold

minesminesNatural off-gassing Natural off-gassing Dental amalgamsDental amalgamsBioaccumulation in Bioaccumulation in

foods esp fishfoods esp fishOld thermometers BP Old thermometers BP

cuffs amp auto cuffs amp auto switchesswitches

Strategies to Reduce Strategies to Reduce Mercury Pollution in Mercury Pollution in

OregonOregonPolicy SolutionsPolicy Solutions Mercury Solutions Act of 2001Mercury Solutions Act of 2001 Ensure safe collection amp recyclingEnsure safe collection amp recycling Clean up abandoned mines and Clean up abandoned mines and

SuperfundsSuperfunds Reduce Hg emissions from health Reduce Hg emissions from health

care facilitiescare facilities Inc Hg in applicable DEQ air amp Inc Hg in applicable DEQ air amp

water permitswater permits Coal burning power plant Boardman Coal burning power plant Boardman

OR OR Implement OR Executive OrderImplement OR Executive Order

What YOU Can Do about What YOU Can Do about MercuryMercury

Advise PatientsAdvise Patients Provide Provide An Expectant Motherrsquos Guide to An Expectant Motherrsquos Guide to

Eating Fish in Oregon (DHS) Eating Fish in Oregon (DHS) in waiting in waiting roomsrooms

Rec WCBA and children avoid fish wHgRec WCBA and children avoid fish wHg Enc WCBA to consume low-fat dietEnc WCBA to consume low-fat diet Recycle old Hg thermometers Recycle old Hg thermometers

thermostats amp fluorescent light tubesthermostats amp fluorescent light tubes Have car checked for Hg switches at Have car checked for Hg switches at

participating auto shop (free participating auto shop (free replacement)replacement)

Use digital thermometers amp thermostatsUse digital thermometers amp thermostats

SummarySummary Chronic Diseases are prevalent Toxic Chronic Diseases are prevalent Toxic

exposures are possible exposures are possible preventablepreventable contributorscontributors

Pesticides amp risk of Parkinsonrsquos and Mercury Pesticides amp risk of Parkinsonrsquos and Mercury risks to WCBA are more understood than most risks to WCBA are more understood than most toxins and other chronic diseasestoxins and other chronic diseases

Apparent toxicity at high doses should be a Apparent toxicity at high doses should be a red flag for possible harm from low dose red flag for possible harm from low dose chronic exposureschronic exposures

Since ldquoproofrdquo of harm materializes slowly Since ldquoproofrdquo of harm materializes slowly generations are at risk and may be harmed generations are at risk and may be harmed before adequate regulatory response occursbefore adequate regulatory response occurs

Kaiser amp HCWHh2eKaiser amp HCWHh2e

Clean Diesel Hospital Zones ProjectClean Diesel Hospital Zones Project Healthy Food in Healthcare InitiativeHealthy Food in Healthcare Initiative Green Building PVC and DEHP free Green Building PVC and DEHP free

NICU NICU Environmentally preferable purchasing Environmentally preferable purchasing

policypolicy Making Medicine Mercury Free Award Making Medicine Mercury Free Award h2e Environmental Leadership Award h2e Environmental Leadership Award

20022002

What Can You DoWhat Can You Do

Be aware of environmental toxins amp Be aware of environmental toxins amp their possible links to chronic diseasestheir possible links to chronic diseases

Provide advice amp education on Provide advice amp education on prevention andor minimizing prevention andor minimizing exposures or refer appropriately exposures or refer appropriately

Incorporate environmental questions Incorporate environmental questions into clinical historyinto clinical history

Advocate Advocate wwwenvirohealthactionorgwwwenvirohealthactionorg

Local AdvocacyLocal Advocacy Oregon Environmental CouncilOregon Environmental Council wwwoeconlineorgwwwoeconlineorg Oregon Collaborative on Health amp Oregon Collaborative on Health amp

EnvironmentEnvironment Healthy Environment ForumsHealthy Environment Forums Oregon Center for Environmental HealthOregon Center for Environmental Health wwworegon-healthorgwwworegon-healthorg Healthcare without HarmHealthcare without Harm Hospitals for Healthy Environment (h2e)Hospitals for Healthy Environment (h2e) Oregon PSROregon PSR wwworegonpsrorgwwworegonpsrorg Environmental Health-In Harmrsquos Way Environmental Health-In Harmrsquos Way

MercuryMercuryDeclining Threshold of Declining Threshold of

HarmHarm

2000199019801970001

01

1

10

100

YEAR

Level associated with harmful effectRegulatory standard (maximum safe exposure or high end exposure from allowed fish contamination)

FDA WHO

EPA

ATSDR

DA

ILY

IN

TA

KE

(mic

rogr

ams

kg

day

Hg)

Sources of MercurySources of MercuryIndustrial emissions Industrial emissions

coal fired plantscoal fired plantsMunicipal amp medical Municipal amp medical

waste incineratorswaste incineratorsAbandoned Hg amp gold Abandoned Hg amp gold

minesminesNatural off-gassing Natural off-gassing Dental amalgamsDental amalgamsBioaccumulation in Bioaccumulation in

foods esp fishfoods esp fishOld thermometers BP Old thermometers BP

cuffs amp auto cuffs amp auto switchesswitches

Strategies to Reduce Strategies to Reduce Mercury Pollution in Mercury Pollution in

OregonOregonPolicy SolutionsPolicy Solutions Mercury Solutions Act of 2001Mercury Solutions Act of 2001 Ensure safe collection amp recyclingEnsure safe collection amp recycling Clean up abandoned mines and Clean up abandoned mines and

SuperfundsSuperfunds Reduce Hg emissions from health Reduce Hg emissions from health

care facilitiescare facilities Inc Hg in applicable DEQ air amp Inc Hg in applicable DEQ air amp

water permitswater permits Coal burning power plant Boardman Coal burning power plant Boardman

OR OR Implement OR Executive OrderImplement OR Executive Order

What YOU Can Do about What YOU Can Do about MercuryMercury

Advise PatientsAdvise Patients Provide Provide An Expectant Motherrsquos Guide to An Expectant Motherrsquos Guide to

Eating Fish in Oregon (DHS) Eating Fish in Oregon (DHS) in waiting in waiting roomsrooms

Rec WCBA and children avoid fish wHgRec WCBA and children avoid fish wHg Enc WCBA to consume low-fat dietEnc WCBA to consume low-fat diet Recycle old Hg thermometers Recycle old Hg thermometers

thermostats amp fluorescent light tubesthermostats amp fluorescent light tubes Have car checked for Hg switches at Have car checked for Hg switches at

participating auto shop (free participating auto shop (free replacement)replacement)

Use digital thermometers amp thermostatsUse digital thermometers amp thermostats

SummarySummary Chronic Diseases are prevalent Toxic Chronic Diseases are prevalent Toxic

exposures are possible exposures are possible preventablepreventable contributorscontributors

Pesticides amp risk of Parkinsonrsquos and Mercury Pesticides amp risk of Parkinsonrsquos and Mercury risks to WCBA are more understood than most risks to WCBA are more understood than most toxins and other chronic diseasestoxins and other chronic diseases

Apparent toxicity at high doses should be a Apparent toxicity at high doses should be a red flag for possible harm from low dose red flag for possible harm from low dose chronic exposureschronic exposures

Since ldquoproofrdquo of harm materializes slowly Since ldquoproofrdquo of harm materializes slowly generations are at risk and may be harmed generations are at risk and may be harmed before adequate regulatory response occursbefore adequate regulatory response occurs

Kaiser amp HCWHh2eKaiser amp HCWHh2e

Clean Diesel Hospital Zones ProjectClean Diesel Hospital Zones Project Healthy Food in Healthcare InitiativeHealthy Food in Healthcare Initiative Green Building PVC and DEHP free Green Building PVC and DEHP free

NICU NICU Environmentally preferable purchasing Environmentally preferable purchasing

policypolicy Making Medicine Mercury Free Award Making Medicine Mercury Free Award h2e Environmental Leadership Award h2e Environmental Leadership Award

20022002

What Can You DoWhat Can You Do

Be aware of environmental toxins amp Be aware of environmental toxins amp their possible links to chronic diseasestheir possible links to chronic diseases

Provide advice amp education on Provide advice amp education on prevention andor minimizing prevention andor minimizing exposures or refer appropriately exposures or refer appropriately

Incorporate environmental questions Incorporate environmental questions into clinical historyinto clinical history

Advocate Advocate wwwenvirohealthactionorgwwwenvirohealthactionorg

Local AdvocacyLocal Advocacy Oregon Environmental CouncilOregon Environmental Council wwwoeconlineorgwwwoeconlineorg Oregon Collaborative on Health amp Oregon Collaborative on Health amp

EnvironmentEnvironment Healthy Environment ForumsHealthy Environment Forums Oregon Center for Environmental HealthOregon Center for Environmental Health wwworegon-healthorgwwworegon-healthorg Healthcare without HarmHealthcare without Harm Hospitals for Healthy Environment (h2e)Hospitals for Healthy Environment (h2e) Oregon PSROregon PSR wwworegonpsrorgwwworegonpsrorg Environmental Health-In Harmrsquos Way Environmental Health-In Harmrsquos Way

Sources of MercurySources of MercuryIndustrial emissions Industrial emissions

coal fired plantscoal fired plantsMunicipal amp medical Municipal amp medical

waste incineratorswaste incineratorsAbandoned Hg amp gold Abandoned Hg amp gold

minesminesNatural off-gassing Natural off-gassing Dental amalgamsDental amalgamsBioaccumulation in Bioaccumulation in

foods esp fishfoods esp fishOld thermometers BP Old thermometers BP

cuffs amp auto cuffs amp auto switchesswitches

Strategies to Reduce Strategies to Reduce Mercury Pollution in Mercury Pollution in

OregonOregonPolicy SolutionsPolicy Solutions Mercury Solutions Act of 2001Mercury Solutions Act of 2001 Ensure safe collection amp recyclingEnsure safe collection amp recycling Clean up abandoned mines and Clean up abandoned mines and

SuperfundsSuperfunds Reduce Hg emissions from health Reduce Hg emissions from health

care facilitiescare facilities Inc Hg in applicable DEQ air amp Inc Hg in applicable DEQ air amp

water permitswater permits Coal burning power plant Boardman Coal burning power plant Boardman

OR OR Implement OR Executive OrderImplement OR Executive Order

What YOU Can Do about What YOU Can Do about MercuryMercury

Advise PatientsAdvise Patients Provide Provide An Expectant Motherrsquos Guide to An Expectant Motherrsquos Guide to

Eating Fish in Oregon (DHS) Eating Fish in Oregon (DHS) in waiting in waiting roomsrooms

Rec WCBA and children avoid fish wHgRec WCBA and children avoid fish wHg Enc WCBA to consume low-fat dietEnc WCBA to consume low-fat diet Recycle old Hg thermometers Recycle old Hg thermometers

thermostats amp fluorescent light tubesthermostats amp fluorescent light tubes Have car checked for Hg switches at Have car checked for Hg switches at

participating auto shop (free participating auto shop (free replacement)replacement)

Use digital thermometers amp thermostatsUse digital thermometers amp thermostats

SummarySummary Chronic Diseases are prevalent Toxic Chronic Diseases are prevalent Toxic

exposures are possible exposures are possible preventablepreventable contributorscontributors

Pesticides amp risk of Parkinsonrsquos and Mercury Pesticides amp risk of Parkinsonrsquos and Mercury risks to WCBA are more understood than most risks to WCBA are more understood than most toxins and other chronic diseasestoxins and other chronic diseases

Apparent toxicity at high doses should be a Apparent toxicity at high doses should be a red flag for possible harm from low dose red flag for possible harm from low dose chronic exposureschronic exposures

Since ldquoproofrdquo of harm materializes slowly Since ldquoproofrdquo of harm materializes slowly generations are at risk and may be harmed generations are at risk and may be harmed before adequate regulatory response occursbefore adequate regulatory response occurs

Kaiser amp HCWHh2eKaiser amp HCWHh2e

Clean Diesel Hospital Zones ProjectClean Diesel Hospital Zones Project Healthy Food in Healthcare InitiativeHealthy Food in Healthcare Initiative Green Building PVC and DEHP free Green Building PVC and DEHP free

NICU NICU Environmentally preferable purchasing Environmentally preferable purchasing

policypolicy Making Medicine Mercury Free Award Making Medicine Mercury Free Award h2e Environmental Leadership Award h2e Environmental Leadership Award

20022002

What Can You DoWhat Can You Do

Be aware of environmental toxins amp Be aware of environmental toxins amp their possible links to chronic diseasestheir possible links to chronic diseases

Provide advice amp education on Provide advice amp education on prevention andor minimizing prevention andor minimizing exposures or refer appropriately exposures or refer appropriately

Incorporate environmental questions Incorporate environmental questions into clinical historyinto clinical history

Advocate Advocate wwwenvirohealthactionorgwwwenvirohealthactionorg

Local AdvocacyLocal Advocacy Oregon Environmental CouncilOregon Environmental Council wwwoeconlineorgwwwoeconlineorg Oregon Collaborative on Health amp Oregon Collaborative on Health amp

EnvironmentEnvironment Healthy Environment ForumsHealthy Environment Forums Oregon Center for Environmental HealthOregon Center for Environmental Health wwworegon-healthorgwwworegon-healthorg Healthcare without HarmHealthcare without Harm Hospitals for Healthy Environment (h2e)Hospitals for Healthy Environment (h2e) Oregon PSROregon PSR wwworegonpsrorgwwworegonpsrorg Environmental Health-In Harmrsquos Way Environmental Health-In Harmrsquos Way

Strategies to Reduce Strategies to Reduce Mercury Pollution in Mercury Pollution in

OregonOregonPolicy SolutionsPolicy Solutions Mercury Solutions Act of 2001Mercury Solutions Act of 2001 Ensure safe collection amp recyclingEnsure safe collection amp recycling Clean up abandoned mines and Clean up abandoned mines and

SuperfundsSuperfunds Reduce Hg emissions from health Reduce Hg emissions from health

care facilitiescare facilities Inc Hg in applicable DEQ air amp Inc Hg in applicable DEQ air amp

water permitswater permits Coal burning power plant Boardman Coal burning power plant Boardman

OR OR Implement OR Executive OrderImplement OR Executive Order

What YOU Can Do about What YOU Can Do about MercuryMercury

Advise PatientsAdvise Patients Provide Provide An Expectant Motherrsquos Guide to An Expectant Motherrsquos Guide to

Eating Fish in Oregon (DHS) Eating Fish in Oregon (DHS) in waiting in waiting roomsrooms

Rec WCBA and children avoid fish wHgRec WCBA and children avoid fish wHg Enc WCBA to consume low-fat dietEnc WCBA to consume low-fat diet Recycle old Hg thermometers Recycle old Hg thermometers

thermostats amp fluorescent light tubesthermostats amp fluorescent light tubes Have car checked for Hg switches at Have car checked for Hg switches at

participating auto shop (free participating auto shop (free replacement)replacement)

Use digital thermometers amp thermostatsUse digital thermometers amp thermostats

SummarySummary Chronic Diseases are prevalent Toxic Chronic Diseases are prevalent Toxic

exposures are possible exposures are possible preventablepreventable contributorscontributors

Pesticides amp risk of Parkinsonrsquos and Mercury Pesticides amp risk of Parkinsonrsquos and Mercury risks to WCBA are more understood than most risks to WCBA are more understood than most toxins and other chronic diseasestoxins and other chronic diseases

Apparent toxicity at high doses should be a Apparent toxicity at high doses should be a red flag for possible harm from low dose red flag for possible harm from low dose chronic exposureschronic exposures

Since ldquoproofrdquo of harm materializes slowly Since ldquoproofrdquo of harm materializes slowly generations are at risk and may be harmed generations are at risk and may be harmed before adequate regulatory response occursbefore adequate regulatory response occurs

Kaiser amp HCWHh2eKaiser amp HCWHh2e

Clean Diesel Hospital Zones ProjectClean Diesel Hospital Zones Project Healthy Food in Healthcare InitiativeHealthy Food in Healthcare Initiative Green Building PVC and DEHP free Green Building PVC and DEHP free

NICU NICU Environmentally preferable purchasing Environmentally preferable purchasing

policypolicy Making Medicine Mercury Free Award Making Medicine Mercury Free Award h2e Environmental Leadership Award h2e Environmental Leadership Award

20022002

What Can You DoWhat Can You Do

Be aware of environmental toxins amp Be aware of environmental toxins amp their possible links to chronic diseasestheir possible links to chronic diseases

Provide advice amp education on Provide advice amp education on prevention andor minimizing prevention andor minimizing exposures or refer appropriately exposures or refer appropriately

Incorporate environmental questions Incorporate environmental questions into clinical historyinto clinical history

Advocate Advocate wwwenvirohealthactionorgwwwenvirohealthactionorg

Local AdvocacyLocal Advocacy Oregon Environmental CouncilOregon Environmental Council wwwoeconlineorgwwwoeconlineorg Oregon Collaborative on Health amp Oregon Collaborative on Health amp

EnvironmentEnvironment Healthy Environment ForumsHealthy Environment Forums Oregon Center for Environmental HealthOregon Center for Environmental Health wwworegon-healthorgwwworegon-healthorg Healthcare without HarmHealthcare without Harm Hospitals for Healthy Environment (h2e)Hospitals for Healthy Environment (h2e) Oregon PSROregon PSR wwworegonpsrorgwwworegonpsrorg Environmental Health-In Harmrsquos Way Environmental Health-In Harmrsquos Way

What YOU Can Do about What YOU Can Do about MercuryMercury

Advise PatientsAdvise Patients Provide Provide An Expectant Motherrsquos Guide to An Expectant Motherrsquos Guide to

Eating Fish in Oregon (DHS) Eating Fish in Oregon (DHS) in waiting in waiting roomsrooms

Rec WCBA and children avoid fish wHgRec WCBA and children avoid fish wHg Enc WCBA to consume low-fat dietEnc WCBA to consume low-fat diet Recycle old Hg thermometers Recycle old Hg thermometers

thermostats amp fluorescent light tubesthermostats amp fluorescent light tubes Have car checked for Hg switches at Have car checked for Hg switches at

participating auto shop (free participating auto shop (free replacement)replacement)

Use digital thermometers amp thermostatsUse digital thermometers amp thermostats

SummarySummary Chronic Diseases are prevalent Toxic Chronic Diseases are prevalent Toxic

exposures are possible exposures are possible preventablepreventable contributorscontributors

Pesticides amp risk of Parkinsonrsquos and Mercury Pesticides amp risk of Parkinsonrsquos and Mercury risks to WCBA are more understood than most risks to WCBA are more understood than most toxins and other chronic diseasestoxins and other chronic diseases

Apparent toxicity at high doses should be a Apparent toxicity at high doses should be a red flag for possible harm from low dose red flag for possible harm from low dose chronic exposureschronic exposures

Since ldquoproofrdquo of harm materializes slowly Since ldquoproofrdquo of harm materializes slowly generations are at risk and may be harmed generations are at risk and may be harmed before adequate regulatory response occursbefore adequate regulatory response occurs

Kaiser amp HCWHh2eKaiser amp HCWHh2e

Clean Diesel Hospital Zones ProjectClean Diesel Hospital Zones Project Healthy Food in Healthcare InitiativeHealthy Food in Healthcare Initiative Green Building PVC and DEHP free Green Building PVC and DEHP free

NICU NICU Environmentally preferable purchasing Environmentally preferable purchasing

policypolicy Making Medicine Mercury Free Award Making Medicine Mercury Free Award h2e Environmental Leadership Award h2e Environmental Leadership Award

20022002

What Can You DoWhat Can You Do

Be aware of environmental toxins amp Be aware of environmental toxins amp their possible links to chronic diseasestheir possible links to chronic diseases

Provide advice amp education on Provide advice amp education on prevention andor minimizing prevention andor minimizing exposures or refer appropriately exposures or refer appropriately

Incorporate environmental questions Incorporate environmental questions into clinical historyinto clinical history

Advocate Advocate wwwenvirohealthactionorgwwwenvirohealthactionorg

Local AdvocacyLocal Advocacy Oregon Environmental CouncilOregon Environmental Council wwwoeconlineorgwwwoeconlineorg Oregon Collaborative on Health amp Oregon Collaborative on Health amp

EnvironmentEnvironment Healthy Environment ForumsHealthy Environment Forums Oregon Center for Environmental HealthOregon Center for Environmental Health wwworegon-healthorgwwworegon-healthorg Healthcare without HarmHealthcare without Harm Hospitals for Healthy Environment (h2e)Hospitals for Healthy Environment (h2e) Oregon PSROregon PSR wwworegonpsrorgwwworegonpsrorg Environmental Health-In Harmrsquos Way Environmental Health-In Harmrsquos Way

SummarySummary Chronic Diseases are prevalent Toxic Chronic Diseases are prevalent Toxic

exposures are possible exposures are possible preventablepreventable contributorscontributors

Pesticides amp risk of Parkinsonrsquos and Mercury Pesticides amp risk of Parkinsonrsquos and Mercury risks to WCBA are more understood than most risks to WCBA are more understood than most toxins and other chronic diseasestoxins and other chronic diseases

Apparent toxicity at high doses should be a Apparent toxicity at high doses should be a red flag for possible harm from low dose red flag for possible harm from low dose chronic exposureschronic exposures

Since ldquoproofrdquo of harm materializes slowly Since ldquoproofrdquo of harm materializes slowly generations are at risk and may be harmed generations are at risk and may be harmed before adequate regulatory response occursbefore adequate regulatory response occurs

Kaiser amp HCWHh2eKaiser amp HCWHh2e

Clean Diesel Hospital Zones ProjectClean Diesel Hospital Zones Project Healthy Food in Healthcare InitiativeHealthy Food in Healthcare Initiative Green Building PVC and DEHP free Green Building PVC and DEHP free

NICU NICU Environmentally preferable purchasing Environmentally preferable purchasing

policypolicy Making Medicine Mercury Free Award Making Medicine Mercury Free Award h2e Environmental Leadership Award h2e Environmental Leadership Award

20022002

What Can You DoWhat Can You Do

Be aware of environmental toxins amp Be aware of environmental toxins amp their possible links to chronic diseasestheir possible links to chronic diseases

Provide advice amp education on Provide advice amp education on prevention andor minimizing prevention andor minimizing exposures or refer appropriately exposures or refer appropriately

Incorporate environmental questions Incorporate environmental questions into clinical historyinto clinical history

Advocate Advocate wwwenvirohealthactionorgwwwenvirohealthactionorg

Local AdvocacyLocal Advocacy Oregon Environmental CouncilOregon Environmental Council wwwoeconlineorgwwwoeconlineorg Oregon Collaborative on Health amp Oregon Collaborative on Health amp

EnvironmentEnvironment Healthy Environment ForumsHealthy Environment Forums Oregon Center for Environmental HealthOregon Center for Environmental Health wwworegon-healthorgwwworegon-healthorg Healthcare without HarmHealthcare without Harm Hospitals for Healthy Environment (h2e)Hospitals for Healthy Environment (h2e) Oregon PSROregon PSR wwworegonpsrorgwwworegonpsrorg Environmental Health-In Harmrsquos Way Environmental Health-In Harmrsquos Way

Kaiser amp HCWHh2eKaiser amp HCWHh2e

Clean Diesel Hospital Zones ProjectClean Diesel Hospital Zones Project Healthy Food in Healthcare InitiativeHealthy Food in Healthcare Initiative Green Building PVC and DEHP free Green Building PVC and DEHP free

NICU NICU Environmentally preferable purchasing Environmentally preferable purchasing

policypolicy Making Medicine Mercury Free Award Making Medicine Mercury Free Award h2e Environmental Leadership Award h2e Environmental Leadership Award

20022002

What Can You DoWhat Can You Do

Be aware of environmental toxins amp Be aware of environmental toxins amp their possible links to chronic diseasestheir possible links to chronic diseases

Provide advice amp education on Provide advice amp education on prevention andor minimizing prevention andor minimizing exposures or refer appropriately exposures or refer appropriately

Incorporate environmental questions Incorporate environmental questions into clinical historyinto clinical history

Advocate Advocate wwwenvirohealthactionorgwwwenvirohealthactionorg

Local AdvocacyLocal Advocacy Oregon Environmental CouncilOregon Environmental Council wwwoeconlineorgwwwoeconlineorg Oregon Collaborative on Health amp Oregon Collaborative on Health amp

EnvironmentEnvironment Healthy Environment ForumsHealthy Environment Forums Oregon Center for Environmental HealthOregon Center for Environmental Health wwworegon-healthorgwwworegon-healthorg Healthcare without HarmHealthcare without Harm Hospitals for Healthy Environment (h2e)Hospitals for Healthy Environment (h2e) Oregon PSROregon PSR wwworegonpsrorgwwworegonpsrorg Environmental Health-In Harmrsquos Way Environmental Health-In Harmrsquos Way

What Can You DoWhat Can You Do

Be aware of environmental toxins amp Be aware of environmental toxins amp their possible links to chronic diseasestheir possible links to chronic diseases

Provide advice amp education on Provide advice amp education on prevention andor minimizing prevention andor minimizing exposures or refer appropriately exposures or refer appropriately

Incorporate environmental questions Incorporate environmental questions into clinical historyinto clinical history

Advocate Advocate wwwenvirohealthactionorgwwwenvirohealthactionorg

Local AdvocacyLocal Advocacy Oregon Environmental CouncilOregon Environmental Council wwwoeconlineorgwwwoeconlineorg Oregon Collaborative on Health amp Oregon Collaborative on Health amp

EnvironmentEnvironment Healthy Environment ForumsHealthy Environment Forums Oregon Center for Environmental HealthOregon Center for Environmental Health wwworegon-healthorgwwworegon-healthorg Healthcare without HarmHealthcare without Harm Hospitals for Healthy Environment (h2e)Hospitals for Healthy Environment (h2e) Oregon PSROregon PSR wwworegonpsrorgwwworegonpsrorg Environmental Health-In Harmrsquos Way Environmental Health-In Harmrsquos Way

Local AdvocacyLocal Advocacy Oregon Environmental CouncilOregon Environmental Council wwwoeconlineorgwwwoeconlineorg Oregon Collaborative on Health amp Oregon Collaborative on Health amp

EnvironmentEnvironment Healthy Environment ForumsHealthy Environment Forums Oregon Center for Environmental HealthOregon Center for Environmental Health wwworegon-healthorgwwworegon-healthorg Healthcare without HarmHealthcare without Harm Hospitals for Healthy Environment (h2e)Hospitals for Healthy Environment (h2e) Oregon PSROregon PSR wwworegonpsrorgwwworegonpsrorg Environmental Health-In Harmrsquos Way Environmental Health-In Harmrsquos Way

wwwhealthandenvironmentorgwwwhealthandenvironmentorg

Conference calls on Conference calls on Environmental HealthEnvironmental Health

CHE Oregon (OEC) CHE Oregon (OEC) Working group on Provider educationWorking group on Provider education Media amp Research GroupMedia amp Research Group

Knowledge - Knowledge - ResponsibilityResponsibility

Hippocratic Oath amp primum non nocere reflect philosophy of prevention and minimizing harm

Precautionary Principle when evidence points toward potentially significant widespread or irreparable harm to health or the environment options to avoid harm should be pursued even if harm is not yet fully understood or proven

Ethical Responsibility to share and use knowledge to prevent and minimize harm

Duty to promote health and well being of patients and community

Possible to be a thoughtful public health advocate in everyday practice