Health Risks or Fifty Years of Denial of Data?

Children who live in homes with vinyl floors, which can emit phtha-lates, are twice as likely to have autism, according to a new study by Swedish and U.S. researchers." So ran the headline on a news story published on March 31, 2009.1 While authors of this study called the findings "intriguing and baffling," the adverse health effects of phthalates—the chemicals used to make vinyl flexible and present in countless consumer products—have caused sufficient concern in recent years that in August 2008, the U.S. Congress, as part of a children's toy safety bill, decided to restrict the use of half a dozen phthalates in products intended for children under age twelve.2 While chemical producers maintain that these compounds are safe, the same six phthalates have been barred from these and additional products in Europe since 2005 and Canada has had phtha-late restrictions in place since 1998.3

Like bisphenol A, phthalates are used so extensively in so many products that most people encounter daily, items ranging from toys to toiletries, that our exposure to these synthetics has a similar potential to be continuous. And while they do not last long in the environment, these chemicals—which have been linked to reproductive and developmental abnormalities, among other endocrine system and health disorders—are so prevalent that as it has with bisphenol A, the U.S. Centers for Disease Control has found phthalates in the majority of Americans it has tested.4 "Today there are no babies born without measurable levels of phthalates," says Shanna Swan, director of the Center for Reproductive Epidemiology at the University of Rochester School of Medicine and Dentistry, who's studied these compounds extensively.5

Phthalates are oily, colorless liquids—based on benzene chemistry— without which PVC (polyvinyl chloride) would be brittle and of limited use. Certain phthalates are used to create thin flexible films, lubricants, and solvents from various vinyl formulations that have both consumer and technical or industrial applications while others make fragrances last longer. There are at least two dozen different types of phthalates (chemically known as phthalate esters) with varying applications, varying molecular structures and, it's been discovered, varying biological activity and health impacts.

In one formulation or another, phthalates, either as plasticizers or fragrance agents, are used not only in toys (among them bath and teething toys) but also in upholstery, shower curtains, wire and cable coatings, car parts, food packaging (particularly coated paper and cardboard prod-ucts6), medical equipment (medical tubing and IV bags, for example), the coatings of time-release medicines, shampoo, perfumes, insect repellants, and countless other products. Phthalates are also used in industrial and photographic film processes. The largest share of phthalates, however, goes into building and construction products—vinyl siding, window frames, doors, fencing, flooring, deck material, and piping (including water pipes)—to name but a few such products. In some bendable PVC products, phthalates can make up as much as 40 to 50 percent of the finished polymer. Over all, about 1 billion pounds or more are produced annually worldwide.

We take these chemicals into our bodies by ingesting them and by breathing them once their molecules have come detached from the materials they modify, and by absorbing them through our skin as we apply cosmetics, creams, lotions, and other skincare products. A study published in 2008 found that babies exposed to phthalates through lotions, powders, baby wipes, and shampoos had more phthalates in their urine than babies on whom these products were not used.7 While phthalates are not environmentally persistent, there are enough of them escaping from products in the built environment that they're being found in wastewater, surface water, and in drinking water sources. But one of the main sources of concern for exposure are the phthalates used in plastic teething toys, vinyl bibs, pacifiers, and other items children chew and suck.

While parents and legislators are now turning to products without phthalates, the American Chemistry Council (ACC), an industry group, says their fears are ungrounded. "There is no reliable evidence that any phthalate has ever caused any harm to any human in their fifty-year history of use," says the ACC.

Yet numerous animal studies conducted since the 1970s indicate that certain phthalates can produce a suite of disturbing health effects—particularly on but not exclusively related to the reproductive system—including what some researchers call "phthalate syndrome." This series of health problems, prompted by insufficient androgen hormones (male sex hormones), results in effects that include reduced sperm production, increased risk of testicular cancer (now the most common cancer in young men), and the genital abnormalities that are currently the most common birth defects among American baby boys. (This condition, called hy-pospadias, the rate of which has doubled in the United States since 1970, is characterized by a defect in the penis that indicates reduced male characteristics.8) There's also evidence that certain phthalates' alteration of thyroid hormone and testosterone function can lead to metabolic disor-ders.9 These compounds may be able to cross the placenta and influence the timing of labor.10 Among the phthalate formulations that have been shown to have anti-androgenic or feminizing effects on male rats exposed just after birth, is one known as diisononyl phtalate or DINP. Exposure to DINP has also caused kidney and liver toxicity in adult mice and rats.11 It is used in plastics and is now barred under the new U.S children's product safety bill. DINP is not bound into the plastic, so it can migrate into saliva and be swallowed if children mouth these products. "We're not yet sure what level of exposure produces these effects, but they are a real concern," says Paul Foster, senior toxicologist at the U.S. National Toxicology Program.12

Chemically, phthalates are hydrocarbon compounds made by varying the composition and structure of what's called benzenecarboxylic acid. Essentially they work by creating a chemical reaction that softens PVC and other polymers, including polyvinyl acetate, which is the base of many adhesives and glues and is also used in cosmetics. Phthalates can also be used as solvents for fragrances that will make the scents linger longer, a property that has made them ingredients of room deodorizers. They are used as lubricants and solvents in lotions. Phthalates make nail polish flexible enough to resist chipping. They enable pigment in mascara to form a flexible film, help eye shadow cling smoothly, and have been used in hairspray to keep the fixative from becoming too brittle. (The phthalate impacts, it should be noted, would be additional to and separate from those linked to the chemical components of vinyl chloride itself, which have been linked to liver and other cancers.13)

Because there are so many different configurations of phthalates, these compounds are trickier to grapple with from a consumer and regulatory perspective than a single substance like bisphenol A. Apart from cosmetics, personal care, and some cleaning products, most items made with phthalates carry no ingredient labels. Food packaging, toys, tools, toothbrushes, and automotive parts are a few such products. And if phthalates are used in proprietary fragrance formulations, as they often are, a label will simply read "fragrance." Even if a product says it's made of PVC or contains polyvinyl acetate, the phthalate or phthalates used as plasticizers may not also be listed, making it hard for consumers to make independent choices about these chemicals.

As has often happened with U.S. environmental policy, American legislative efforts to curtail use of phthalates began in California. In 2006, San Francisco began prohibiting the six phthalates banned in Europe (these include DEHP, DINP and benzylbutyl phthalate, all used in PVC, as well as dibutyl phthalate, widely used in cosmetics) from toys and other products intended for children under three. The following year, the same substances were banned from comparable products throughout

California.14 Since 2006—and in advance of any federal legislation—a number of other states have proposed similar restrictions, often in the company of bills that would also curtail use of bisphenol A and PBDE flame retardants.15 The chemical industry has characterized such legislation as an overreaction to the risk posed by actual phthalate exposure, a response thus far echoed by both the U.S. Consumer Product Safety Commission and Food and Drug Administration.16

But moving ahead of the regulatory curve—and responding to consumer concern—many U.S. and international manufacturers, including Mattel, Procter & Gamble, L'Oreal, Nike, and Dell to name just a few, have already removed or are phasing out certain phthalates from various cosmetics, personal care, and infant products and are among the companies now offering phthalate-free sports gear, toys, cleaning products, and medical and electronic equipment. This, of course, makes good business sense. No one wants to be stuck with a line of products—a process—that is out of regulatory compliance or that the public is afraid to buy.

As has happened with other European hazardous materials restric-tions—specifically regulations that curtail the use of certain toxic chemicals in electronics—the EU's restrictions on phthalates have spread to products destined for a wider international market. Since the EU ban of dibutyl phthalate (DBP) from cosmetics, for example, a number of major cosmetics manufacturers have removed the chemical from products sold internationally. Although these technical and tongue-twisting chemical names sound obscure, I knew this issue had reached the American mainstream when in the summer of 2007, my local newspaper's Sunday coupon inserts included one for Revlon nail polish that declared it "DBP-Free."

DBP-free nail polish may now be easy to find at the neighborhood drugstore, but another phthalate, diethylbutyl phthalate (DEP), is not yet restricted anywhere, although some U.S. state legislatures have proposed bills that would restrict its use. DEP is commonly used in personal care products, fragrances, and as a plasticizer as well as products that come into contact with food: treated papers, foils, and some of the clear plastics used as windows on bakery boxes. Food samples taken in the United

States and the UK have found DEP in baked goods—cakes, crackers, cookies—and candy, all presumed to have migrated from the packaging.17 Since packaging typically carries no materials labeling, without regulation it's impossible to know if your candy bar might come with traces of phthalate.

Like other phthalates, DEP is easily absorbed through the skin and can be widely distributed through the body although it does not bio-accumulate, according to research published by the World Health Organization.18 Human exposure, this research indicates, can be significant, occurring directly through the use of products containing DEP and environmentally from DEP that's entered air, water, and soil from waste, from manufacturing, and from products themselves. DEP has been found in wastewater in the United States, tap water in Japan, and in surface water in the United States, Canada, the UK, and various other European countries among other locations—ample evidence of its prevalence.

The U.S. Agency for Toxic Substances and Disease Registry (ATSDR) currently says there is no information about DEP's toxicity to humans who breathe, eat, or drink it. Yet according to the agency's website, "Some birth defects occurred in rats that received high doses of diethyl phthalate by injection during pregnancy." But, notes the ATSDR, "Humans are not exposed to diethyl phthalate by this route." So the significance of these findings is subject to debate.19 In other phthalate studies, large doses of DBP (dibutyl phthalate) have caused tumors in lab rats and very large doses have lowered the quality of sperm produced.20 Whether this can happen as a result of exposure to phthalates encountered environmentally is not known. Yet given that the reproductive system health problems being seen in people parallel the effects phthalates produce in animal studies, Paul Foster says he thinks these compounds are "really something to worry about."21

While manufacturers and consumers began to opt for products without phthalates, the Phthalates Esters Panel of the American Chemistry Council—an industry group made up of phthalate manufacturers including Eastman Chemical, BASF, Exxon Mobil, and the Ferro Corporation— continued to maintain that these compounds pose no human health risks and even asserted in a 2008 press conference that restrictions in the new U.S. children's product safety bill were "not based on science."22

"There is no scientific basis for Congress to restrict phthalates from toys and children's products. With over fifty years of research, phthalates are among the most thoroughly studied products in the world, and have been reviewed by multiple regulatory bodies in the U.S. and Europe," the American Chemistry Council announced in response to the 2008 legislation. The Phthalates Esters Panel media information kit, meanwhile, asserted that "there is no reliable evidence that any phthalate has ever caused any harm to anyone."23 These and other bulletins issues by the American Chemistry Council claimed that there was insufficient evidence in any of the studies conducted thus far to infer that phthalates might cause any human reproductive health problems. In answer to the question, "Aren't phthalates endocrine disruptors?" the industry resource response was, "In lab tests with rodents, phthalates do not block the action of male or female hormones, or mimic their behavior."

Following the research into the behavior and health effects of commonly used phthalates, however, I found a somewhat different story. Concern about adverse effects of phthalates and their ability to migrate out of finished products seems to have burst onto the public scene in the United States only over the past several years, but it's been in scientific sights for more than forty years. The National Institutes of Health publication Environmental Health Perspectives, for example, devoted an entire issue to phthalate esters in 1973. The concerns raised then were of two kinds, not always related. One was concern over emerging evidence of phthalates' adverse health effects. The other was over the migration of phthalates from the plastics and polymers of which they were constituents and their ability to contaminate other substances—concerns that were discussed in the early 1960s.

In their introductory essay to that special issue, the editors pointed to the migration of phthalates into human blood in medical settings, with some nascent concerns about the resulting health effects. At that time phthalates had been found in both blood stored in PVC bags and in patients who'd received such blood in transfusions. Ten years later, phthalate contamination of blood stored in PVC bags was discussed at a 1982 conference. But, given the inconclusive evidence about the precise health effects of such exposure—including the then recently conducted studies that indicated DEHP might be a carcinogen—this concern was not shared with patients, "such as hemophiliacs and leukemics, whom we feel are sufficiently burdened, and need not be concerned with questionable numbers at this time," noted J. C. Fratanoni of the FDA's Division of Blood and Blood Products.

Another paper published in 1973 based on studies done in Germany in the 1960s found phthalates leaching out of PVC tubes used for milking.24 Concern about phthalates' tendency to migrate from PVC and other polymers also came from researchers at the NASA Goddard Space Center who were mainly interested in potential phthalate corruption of instrumentation, including sensitive mirrors and lenses. Space vessels, given their enclosed environments, are by nature self-contaminating, and officials banned polyvinyl chlorides as a result. But PVC was so widely used that phthalates were often found on spacecraft equipment or in these enclosed environments anyway as a result of PVC use in other equipment involved in preparation of items destined for spacecraft—including the air filters designed to remove contaminants.25

The degradation of polymers (and other materials) used on spacecraft and submarines had already been a concern for a least a decade. In 1963, the Aerospace Medical Division of the U.S. Air Force produced a report examining the enclosed environment air-contamination potential of materials and their chemical constituents. This report noted the potential of large fluorinated polymers, such as Teflon, to break down "into free radicals which unzip into monomers," and of "hydrocarbon type polymers" to "give off various hydrocarbon products of degradations such as methane, ethylene, and longer chain hydrocarbons." The authors also noted that "polymers containing chlorine may evolve into hydrogen chloride and possibly, phosgene." (The last concern, however, was focused on degradation of the refrigerant Freon rather than of polymers.26)

Forty years later, researchers at NASA released a white paper that discussed contamination of Mars landing vehicles by substances resulting from polymer degradation and off-gassing—contamination from DEHP and other compounds that could interfere with the vehicles' measurement equipment.271 asked David Beaty, an author of the paper and chief scientist for NASA's Mars exploration program, about this. When searching for signals of life on Mars, it's important, Beaty explained, to be able to separate out "signal—if any—from noise." Therefore it's important for NASA scientists to know precisely which contaminants—including plasti-cizers—might migrate out of polymers, adhesive or coatings, for example, so that they can be taken out of the equation. Instrument function is also a concern, Beaty told me. It's not that phthalates themselves have caused problems, but that their migration is a reality that needs to be dealt with.

Even though NASA and others have recognized phthalate migration for decades, there is still resistance among industry trade groups. During a 2008 press teleconference held by the Phthalate Esters Panel of the American Chemistry Council, Dean Finney, a consultant with more than forty years experience working with phthalates, including thirty-eight years with Eastman Chemical, a manufacturer of phthalates, asserted without modification that phthalates "do not migrate" or "off gas."28

Because there are so many different types of phthalates, it's easy to become confused about which kinds are used in which products and, therefore, which compounds may be of particular concern in terms of human exposure. Bulletins issued by the Phthalates Ester Panel to defend phtha-late safety have used this confusion to underscore lack of public understanding about these chemicals and to point to inaccuracies in report-ing.29 Yet adding to the complexity of phthalate behavior is the fact that once inside a human or other animal body these compounds break down into smaller—and, it turns out, biologically active—molecules known as metabolites. These are what will be present in blood and urine, so it's these phthalate metabolites, rather than the parent compounds, that the Centers for Disease Control has been measuring in its surveys of Americans' chemical exposures.

These metabolites are also what appear to be causing phthalates' observed health effects. As Paul Foster explains, while phthalates may at first be present in a mother-to-be (for example) in a nontoxic form, by the time her body has processed the compounds, they will likely be broken down into a reactive form that can then interact with her developing fetus. Further, as environmental health expert Dr. Ted Schettler told me, individual phthalate metabolites can cause different health effects.30

For example, a study published in 2007 found a link between a particular metabolite of DEHP—the most widely used PVC plasticizer—and altered thyroid hormone function.31 (DEHP can also cause respiratory and immunological problems.) Another study, published in 2006, found that infants exposed to phthalates from PVC in medical equipment had concentrations of the resulting, biologically active metabolites in their urine, molecules that have been linked to adverse impacts on reproductive development.32

If these exposures take place very early in life, the changes produced by these chemicals can affect what Foster calls "primordial germ cells"— the cells that develop into eggs or sperm. These effects, he explains—like those induced by bisphenol A and the endocrine disruptors studied by Bruce Blumberg, Retha Newbold, and their colleagues—are permanent changes. This means that exposure before birth can prompt health effects that remain with an individual for life. ^ ^ ^

Before delving further into how different phthalate metabolites behave, one way to begin thinking about or categorizing how different phtha-lates are used—and therefore how people may become exposed—is to understand that, generally, the physically bigger, heavier, formulations, including DEHP, are most often used with larger and bulkier materials like PVC. Molecularly lighter phthalates, including DBP (dibutyl benzyl phthalate), are used in more structurally delicate applications, such as ad-hesives or dyes, to lubricate textile fibers, in pesticides, and as part of the polyvinyl acetate emulsions used in glues, paints, and other coatings, including cosmetics.33

DEHP makes up about half of all such plasticizers used worldwide. In 2005, Chemical & Engineering News reported that about 300,000 tons were used annually in Europe.34 U.S. production volume of DEHP, however, was a trade secret. Scores of studies undertaken since 2000 indicate that exposure to DEHP, especially before or shortly after birth, can adversely effect reproductive development, particularly in male infants. One source of such exposure is through medical equipment used in care of premature infants and developing embryos.35

Paul Foster points out that the male reproductive effects produced by DEHP and DBP exposure in humans can happen in the first or second trimester of pregnancy. This means it's entirely possible, he notes, that exposure to phthalates—or any other chemical that acts similarly—could take place before a woman might even be aware that she's pregnant, and therefore before she would have had a chance to take action to reduce her exposure. This also points again to the difficulty of relying on traditional toxicology to protect against chemical hazards: Here, timing of exposure may be as important a marker of toxicity as dose.

That many of the adverse health impacts of phthalates—like other endocrine disruptors—are subtle and do not fit into a direct cause-and-effect scenario makes them challenging to contend with from a regulatory perspective. That said, by the early 1970s, some rather dramatic changes had already been observed in lab animals exposed to phthalates. Research in 1973 at the University of Tennessee Medical Unit's Science Toxicology Laboratories noted that, compared to relevant control groups of research they had surveyed, "all of the PAEs [phthalic acid esters or phthalates] studies showed a deleterious effect upon the developing embryo and/or fetus. At one or more of the dose levels employed, some or all of the following effects were observed for each compound: resorptions [when the body or a cell absorbs a substance that it's losing, including an unviable fetus], gross abnormalities, skeletal malformations, fetal death, or decreased fetal size."36 Abnormalities included lack of tail, twisted hind legs, and malformed ribs and skulls.

Researchers from the U.S. Food and Drug Administration followed up on these findings in 1982 with an assessment of the most toxic of the phthalates tested by the Tennessee researchers, dimethoxyethyl phthalate (DMEP), and found similarly toxic effects. The majority of rats exposed to DMEP in the early days of pregnancy produced fetuses with multiple malformations, among them serious defects in bone structure and the brain. Researchers also noted that phthalate exposure affected how the rats processed zinc, an element that appears to play a role in the development and behavior of male sex hormones.37 The multiple congenital skeletal malformations resulting from this phthalate exposure prompted the study authors to make the comparison to thalidomide, a drug prescribed to pregnant women in the 1960s to treat morning sickness that resulted in severe birth defects, among them missing limbs.38

A specialty plasticizer, DMEP has been used in photographic compounds and various film applications. Xerox, Eastman Kodak, and Polaroid have held patents for products that might incorporate DMEP, while Eastman Kodak, Philip Morris, and others have also held patents that list DMEP as a component of cigarette filters. Although the compound is restricted in Europe, having been classified as toxic to reproduction by the European Commission, and also listed on the U.S. EPA's Toxic Substances Control Act Inventory (simply a list of chemicals used and produced commercially in the United States) since 1979, it is still manufactured and available for bulk purchase and therefore presumably still being used. Most of the manufacturers I found in a 2008 search were in China, but products made with DMEP have hit the world market, having been found in Australia in children's toys and exercise balls.39

In 1982, another U.S. government agency, the National Toxicology Program, that had been scrutinizing the health effects of three widely used phthalates—including DEHP—released the results of its investigation.40 In that study DEHP was found to produce liver tumors in both rats and mice tested, and therefore was deemed a carcinogen—the official wording being that DEHP is "reasonably anticipated" to be carcinogenic to humans," a judgment also adopted by the EPA and Centers for Disease Control but still being debated both within the United States and inter-nationally.41 The Phthalates Esters Panel website does not include this health hazard information, however, but instead mentions that the U.S. Consumer Product Safety Commission does not consider another phtha-late, DINP (used extensively in vinyl toys, including teething toys), to be a human carcinogen. More than twenty-five years after this National Toxicology Program assessment, and billions of pounds of phthalates later, the upshot is that in the United States—among other places—DEHP use is still largely unregulated.

In August 2008, following signing of the U.S. toy safety bill that restricts (but does not completely ban) six phthalates—including DEHP, DBP, and DINP but not DEP—from children's products, the Phthalate Esters Panel held a press conference to dispel concerns about the health impacts of these compounds. To do so, Ray David, a toxicologist with the BASF Corporation (an international chemicals manufacturer), pointed out flaws and uncertainties in several recent phthalate studies and emphasized the uncertainty of applying animal study results to people. "Phtha-lates are one of the most thoroughly tested families of compounds in use today," says the American Chemistry Council.42 "No one," said David, "has come to any conclusion that phthalates are a risk for the human population." ^ ^ ^

In the absence of definitive guidelines on materials like polycarbonates and phthalates, faced with conflicting information, and with so many studies showing adverse health effects, what's a consumer to do? The general stance from the American Chemistry Council is that the precautionary principle disregards science, but the advice from scientists I've spoken to is to be strategic and to make choices that have the greatest potential health benefits for you and your family.43

What that entails is open to interpretation. One can take a radical approach like Theo Colborn and eschew plastic containers altogether. "I put everything in glass," she told me. One can follow Fred vom Saal who says he never uses plastic dishes for hot food or in the microwave. Or one can take the specific pragmatic advice offered by such researchers as Patricia Hunt and Hugh Taylor.

"A primary route of exposure is ingestion," says Taylor of bisphenol A. So "bisphenol A is easy to avoid when pregnant. Don't eat canned goods, don't have dental sealants put in unless absolutely necessary, and use glass instead of plastic water bottles," he told me.44 Hunt advises avoiding polycarbonate plastics when they become visibly rough—a sign of degradation that can indicate bisphenol A leaching (something the American Chemistry Council disputes).45

Although the presence of phthalates is trickier to avoid since they appear in so many variations—often completely without labeling—the scientists I spoke to advise a strategy similar to that suggested for protecting against bisphenol A exposure. Avoiding PVC products while pregnant— particularly in contact with food—can help prevent exposing a developing baby, says Shanna Swan. Like Swan, Paul Foster suggests that women who pregnant are or planning to become pregnant should take the most precautions.46

Not pregnant and not feeding a child, I've been wondering how finicky I should be about these compounds. The first time I heard about bisphenol A was at a lecture in 2005. After the talk, I went home and peered at the bottom of all my plastic containers, searching for a telltale sign indicating polycarbonate. (Typically this is a #7 or the word "other," but much polycarbonate is unlabeled.) I've since switched to stainless steel refillable water bottles and travel mugs and use a ceramic filter or glass to make coffee. And while I've never used plastic dishes or put plastic in a microwave, I've started to think twice about putting hot leftovers directly in any kind of plastic.

As for phthalates, I've become a ferocious reader of the tiny type on containers of anything I might use in the bathroom. I avoid anything that says "fragrance" and have learned that even "unscented" products often list "fragrance" as an ingredient. When it comes to vinyl, I won't choose it but I know there's PVC coated wiring in my house and attached to appliances. (Work is going on to design alternatives, but thus far non-PVC or other halogen-free coated wiring is not yet readily available for residential use, certainly not yet at a price that would challenge the PVC wiring now on the market.) At some point I'd like to replace the vinyl kitchen and bathroom flooring, but while I'm saving up to do that, I pay closer attention than ever before to what touches my food and skin, and I ask questions about anything new that comes into the house.

Still, a great many of the products that populate our lives carry no materials listings or have ingredients that require a major sleuthing expedition to discover—something most people are not prepared, willing, or even able to undertake. Often the people who are least likely to scan ingredient labels or to have considered these issues may be those whose circumstances make them particularly vulnerable to potential chemical hazards. This is true everywhere but particularly in less wealthy coun-tries—and the latter often get overlooked in discussions of new and environmentally improved materials.

At the same time, not all products with the same ingredients listings are created equally well. One of the issues with materials that carry names like "vitamin E," for example, has to do with the compounds' source and production. There are vitamins, minerals, perfumes, and oils derived from naturally occurring sources and there are products with the same names that may be synthetics. Being a synthetic does not necessarily indicate a problem, but folks like those watchdogging the supply chain at the Environmental Working Group want to know where stuff comes from and how it was made before declaring it free of hazards. Given recent history with products as diverse as peanuts, milk, toy trains, pet food, and toothpaste, this seems to me a reasonable strategy. ^ ^ ^

When it comes to a number of widely used, and therefore pervasive, mobile synthetics with adverse health impacts that are now well documented, the principle of precaution is slowly gaining ground in the United States. For example, independent of any regulation or legislation, as concern about the health effects of phthalates has grown, a number of hospitals have begun to move away from PVC products that contain DEHP. The organization Health Care Without Harm lists dozens of hospitals now doing so.47 Health Care Without Harm also catalogues the PVC-free products now available for almost every hospital or medical use, from IV tubes, catheters, and blood bags to disposable gloves, flooring, cubicle materials, wall coverings, shower curtains, and office supplies. It's probably entirely unreasonable to avoid medical care for fear of phthalate exposure, but that there are hospitals using alternative products means, for example, that when available, one might be able to choose a PVC-free environment for obstetric and neonatal care. Meanwhile, the trade associations of the plastics manufacturers hold out hope that phthalates and bisphenol A will some day soon be given a clean bill of health.

Asked how to reconcile the blatantly contradictory statements coming from manufacturers of bisphenol A products, phthalates, and other so-called endocrine-disrupting chemicals and those coming from independent scientists, Shanna Swan utters the phrase "tobacco science." She cautions against consumer overreaction but points out that it was thirty years between the Surgeon General's Warning about cigarettes and the industry taking responsibility for tobacco's health impacts. Ted Schettler cautions against such a precise comparison because the modes of exposure differ so distinctly, but characterizes the chemical industry's stance on phthalates as "fifty years of complete denial of data."48

"Scientists never all agree," says Patricia Hunt. "There is always going to be controversy." Yet, she says, "If we wait it may be too late."

Continue reading here: The Persistent and Pernicious

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